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3. Landiolol for heart rate control in patients with septic shock and persistent tachycardia. A multicenter randomized clinical trial (Landi-SEP)

Author

Rehberg, Sebastian, Frank, Sandra, Černý, Vladimír, Cihlář, Radek, Borgstedt, Rainer, Biancofiore, Gianni, Guarracino, Fabio, Schober, Andreas, Trimmel, Helmut, Pernerstorfer, Thomas, Siebers, Christian, Dostál, Pavel, Morelli, Andrea, Joannidis, Michael, Pretsch, Ingrid, Fuchs, Christian, Rahmel, Tim, Podbregar, Matej, Duliczki, Éva, Tamme, Kadri, Unger, Martin, Sus, Jan, Klade, Christoph, Krejcy, Kurt, Kirchbaumer-Baroian, Nairi, Krumpl, Günther, and Duška, František

Published
2024
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15. Life‐Threatening Anaphylaxis due to Cerebrolysin®.

Author

Trimmel, Helmut, Tauber, Wolfgang, Zikeli, Martin, and Berlit, Peter

Subjects
*CONSCIOUSNESS raising, *NEUROPEPTIDES, *ANAPHYLAXIS, *BRAIN injuries, *NEUROLOGICAL disorders
Abstract

In this case report, we describe a well‐documented, severe anaphylactic reaction after intravenous administration of cerebrolysin, a neurotrophic agent derived from highly purified porcine brain tissue, consisting of peptides and free amino acids. Cerebrolysin has been in use for decades, in various neurological diseases, but especially stroke and traumatic brain injury, with the aim of enhancing cognitive performance. After administration of cerebrolysin to an 85‐year‐old male patient suffering from subacute stroke, he developed a fulminant anaphylactic reaction. Following institutional standards, vital functions were quickly restored. The anaphylactic reaction was clearly confirmed by laboratory tests. To date, only rare cases of anaphylaxis due to cerebrolysin have been published in the literature. The current report is intended to raise awareness for the possibility of such a reaction, given the widespread use of cerebrolysin in several indications in mostly critical patients. The case shows how a completely unexpected life‐threatening situation can be successfully treated by targeted measures, if the situation is recognized quickly. In light of this event, we consider pathophysiology of allergic reactions and treatment guidelines. [ABSTRACT FROM AUTHOR]

Published
2024
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16. Landiolol for heart rate control in patients with septic shock and persistent tachycardia A multicenter Randomized Clinical Trial (Landi-SEP)

Author

Rehberg, Sebastian, primary, Frank, Sandra, additional, Černý, Vladimír, additional, Cihlář, Radek, additional, Borgstedt, Rainer, additional, Biancofiore, Gíanni, additional, Guarracino, Fabio, additional, Schober, Andreas, additional, Trimmel, Helmut, additional, Pernerstorfer, Thomas, additional, Siebers, Christian, additional, Dostál, Pavel, additional, Morelli, Andrea, additional, Joannidis, Michael, additional, Pretsch, Ingrid, additional, Fuchs, Christian, additional, Rahmel, Tim, additional, Podbregar, Matej, additional, Duliczki, Éva, additional, Tamme, Kadri, additional, Unger, Martin, additional, Sus, Jan, additional, Klade, Christoph, additional, Kirchbaumer-Baroian, Nairi, additional, Krejcy, Kurt, additional, Krumpl, Günther, additional, and Duška, František, additional

Published
2024
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20. Care of the critically ill begins in the emergency medicine setting

Author

Al-Hadad, Mo, Arafat, Raed, Baker, Tim, Balik, Martin, Behringer, Wilhelm, Brown, Ruth, Carenzo, Luca, Connolly, Jim, Dankl, Daniel, Dodt, Christoph, Dünser, Martin W., Exadaktylos, Aristomenis, Gauss, Tobias, Gavrilovic, Srdjan, Hachimi-Idrissi, Said, Haenggi, Matthias, Herkner, Harald, Joannidis, Michael, Khoury, Abdo, Klinglmair, Michaela, Leach, Robert, Leone, Marc, Lockey, David, Meier, Jens, Noitz, Matthias, Petrino, Roberta, Petros, Sirak, Plaisance, Patrick, Preller, Jacobus, Riesgo, Luis Garcia-Castrillo, Schell, Carl Otto, Šeblová, Jana, Sitzwohl, Christian, Skjaerbaek, Christian Baaner, Skrifvars, Markus, Sunde, Kjetil, Mahečić, Tina Tomić, Trimmel, Helmut, Valentin, Andreas, and Wenzel, Volker

Published
2024
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22. The authors reply

Author

Kreutziger, Janett, Hornung, Sonja, Harrer, Clemens, Urschl, Wilhelm, Doppler, Reinhard, Voelckel, Wolfgang G., and Trimmel, Helmut

Published
2020
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24. Citicoline for the management of patients with traumatic brain injury in the acute phase: a systematic review and meta-analysis

Author

Universitat Politècnica de Catalunya. Departament d'Estadística i Investigació Operativa, Universitat Politècnica de Catalunya. GNOM - Grup d'Optimització Numèrica i Modelització, Secades Ruiz, Julio José, Trimmel, Helmut, Salazar, Byron, González Alastrué, José Antonio, Universitat Politècnica de Catalunya. Departament d'Estadística i Investigació Operativa, Universitat Politècnica de Catalunya. GNOM - Grup d'Optimització Numèrica i Modelització, Secades Ruiz, Julio José, Trimmel, Helmut, Salazar, Byron, and González Alastrué, José Antonio

Abstract

Background: Citicoline or CDP-choline is a neuroprotective/neurorestorative drug used in several countries for the treatment of traumatic brain injury (TBI). Since the publication of the controversial COBRIT, the use of citicoline has been questioned in this indication, so it was considered necessary to undertake a systematic review and meta-analysis to evaluate whether citicoline is effective in the treatment of patients with TBI. Methods: A systematic search was performed on OVID-Medline, EMBASE, Google Scholar, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Ferrer databases, from inception to January 2021, to identify all published, unconfounded, comparative clinical trials of citicoline in the acute phase of head-injured patients—that is, treatment started during the first 24 h. We selected studies on complicated mild, moderate, and severe head-injured patients according to the score of the Glasgow Coma Scale (GCS). The primary efficacy measure was independence at the end of the scheduled clinical trial follow-up. Results: In total, 11 clinical studies enrolling 2771 patients were identified by the end. Under the random-effects model, treatment with citicoline was associated with a significantly higher rate of independence (RR, 1.18; 95% CI = 1.05–1.33; I2, 42.6%). The dose of citicoline or the administration route had no effect on outcomes. Additionally, no significant effects on mortality were found, and no safety concerns were noticed. Conclusions: This meta-analysis indicates some beneficial effects of citicoline’s increasing the number of independent patients with TBI. The most important limitation of our meta-analysis was the presumed heterogeneity of the studies included. Registration: PROSPERO CRD42021238998, Peer Reviewed, Postprint (published version)

Published
2023

25. EuReCa ONE⿿27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe

Author

Kaufmann, Marc, Thaler, Markus, Maier, Martin, Prause, Gerhard, Trimmel, Helmut, de Longueville, Diane, Preseau, Thierry, Biarent, Dominique, Melot, Christian, Mpotos, Nicolas, Monsieurs, Koen, Van de Voorde, Patrick, Vanhove, Marie, Lievens, Pascale, Faniel, Mathias, Keleuva, Slobodanka, Lazarevic, Milan, Ujevic, Radmila Majhen, Devcic, Mato, Bardak, Branka, Barisic, Fabijan, Anticevic, Silvija Hunyadi, Georgiou, Marios, Truhláſ, Anatolij, Knor, Jiſí, Smržová, Eva, Sviták, Roman, Šín, Robin, Mokrejš, Petr, Lippert, Freddy K., Hallikainen, Juhana, Hoikka, Marko, Iirola, Timo, Jama, Timo, Jäntti, Helena, Jokisalo, Raimo, Jousi, Milla, Kirves, Hetti, Kuisma, Markku, Laine, Jukka, Länkimäki, Sami, Loikas, Petri, Lund, Vesa, Määttä, Teuvo, Nal, Heini, Niemelä, Heimo, Portaankorva, Petra, Pylkkänen, Marko, Sainio, Marko, Setälä, Piritta, Tervo, Jerry, Väyrynen, Taneli, Murgue, Davy, Champenois, Anne, Fournier, Marc, Meyran, Daniel, Tabary, Romain, Avondo, Aurélie, Gelin, Gelin, Simonnet, Bruno, Joly, Marc, Megy-Michoux, Isabelle, Paringaux, Xavier, Duffait, Yves, Vial, Michael, Segard, Julien, Narcisse, Sophie, Hamban, David, Hennache, Jonathan, Thiriez, Sylvain, Doukhan, Mathieu, Vanderstraeten, Carine, Morel, Jean-Charles, Majour, Gilles, Michenet, Corinne, Tritsch, Laurent, Dubesset, Marc, Peguet, Olivier, Pinero, David, Guillaumee, Fréderic, Fuster, Patrick, Ciacala, Jean-François, Jardel, Benoît, Letarnec, Jean-Yves, Goes, Frank, Gosset, Pierre, Vergne, Muriel, Bar, Christian, Branche, Fabienne, Prineau, Stevens, Lagadec, Steven, Cornaglia, Carole, Ursat, Cécile, Bertrand, Philippe, Agostinucci, Jean-Marc, Nadiras, Pierre, de Linares, Géraldine Gonzales, Jacob, Line, Revaux, François, Pernot, Thomas, Roudiak, Nathalie, Ricard-Hibon, Agnès, Villain-Coquet, Laurent, Beckers, Stefan, Hanff, Thomas, Strickmann, Bernd, Wiegand, Nicolai, Wilke, Petra, Sues, Harald, Bogatzki, Stefan, Baumeier, Wolfgang, Pohl, Kai, Werner, Bert, Fischer, Hans, Zeng, Torsten, Popp, Erik, Günther, Andreas, Hochberg, Andreas, Lechleuthner, Alex, Schewe, Jens-Christian, Lemke, Hans, Wranze-Bielefeld, Erich, Bohn, Andreas, Roessler, Markus, Naujoks, Frank, Sensen, Frank, Esser, Torben, Fischer, Matthias, Messelken, Martin, Rose, Christopher, Schlüter, Gabriele, Lotz, Wolfgang, Corzilius, Michael, Muth, Claus-Martin, Diepenseifen, Christian, Tauchmann, Björn, Birkholz, Torsten, Flemming, Andreas, Herrmann, Stefanie, Kreimeier, Uwe, Kill, Clemens, Marx, Frank, Schröder, Ralph, Lenz, Wolfgang, Botini, Glykeria, Grigorios, Barakos, Giannakoudakis, Nikolaos, Zervopoulos, Michail, Papangelis, Dimitrios, Petropoulou-Papanastasiou, Sofia, Liaskos, Themistoklis, Papanikolaou, Spyridon, Karabinis, Andreas, Zentay, Attila, ÿorsteinsson, Hólmgeir, Gilsdóttir, Anna, Birgisson, Svavar A., Guðmundsson, Fjölnir Freyr, Hreiðarsson, Hallgrímur, ÿrnason, Björgvin, Hermannsson, Hermann, Björnsson, Gísli, Friðriksson, Brynjar ÿór, Baldursson, Gunnar, Höskuldsson, ÿrmann, Valgarðsdottir, Jórunn, ÿsmundardóttir, Matthildur, Guðmundsson, Guðmundur, Kristjánsson, Hjörtur, ÿórarinsson, Eyþór Rúnar, Guðlaugsson, Jón, Skarphéðinsson, Sigurður, Peratoner, Alberto, Santarelli, Andrea, Sabetta, Cesare, Gordini, Giovanni, Sesana, Giovanni, Giudici, Riccardo, Savastano, Simone, Pellis, Tommaso, Beissel, Jean, Uhrig, Jean, Manderscheid, Tom, Klop, Marco, Stammet, Pascal, Koch, Marc, Welter, Philippe, Schuman, Robert, Bruins, Wendy, Amin, Hesam, Braa, Nina, Bratland, Staale, Buanes, Eirik Alnes, Draegni, Tomas, Johnsen, Knut Roar, Mathisen, Wenche Torunn, Oedegaarden, Terje, Oppedal, Marie, Reksten, Alf Stolt-Nielsen, Roedsand, Mats Eirik, Steen-Hansen, Jon Erik, Dyrda, Marta, Frejlich, Anna, MaciĿg, Sſawomir, Osadnik, Sonia, Weryk, Ireneusz, Mendonça, Eugénio, Freitas, Carlos, Cruz, Pinto, Caldeira, Carmo, Barros, José, Vale, Luis, Brazão, António, Jardim, Nuno, Rocha, Fernanda, Duarte, Ricardo, Fernandes, Nicodemos, Ramos, Pedro, Jardim, Margarida, Reis, Miguel, Ribeiro, Romulo, Zenha, Sérgio, Fernandes, Jorge, Francisco, Juan, Assis, David, Abreu, Fernanda, Freitas, Dinarte, Ribeiro, Leonardo, Azevedo, Paulo, Calafatinho, Débora, Jardim, Rui, Pestana, Aleixo, Faria, Rui, Oprita, Bogdan, Grasu, Alis, Nedelea, Paul, Sovar, Sorina, Agapi, Florin, KliĿkoviĿ, Aleksandar, LaziĿ, Aleksandra, NikoliĿ, Bogdan, Zivanovic, Bogdan, MartinoviĿ, Branislav, MilenkoviĿ, Dušan, Damir, HuseinoviĿ, Koprivica, Jovanka, JakšiĿ, Kornelija Horvat, Pajor, Margit, MiliĿ, Saša, VidoviĿ, Mirko, Glamoclija, Radojka Petrovic, Andjelic, Sladjana, Sladjana, Vlajovic, BabiĿ, Zlatko, Fišer, Zlatko, Androvic, Peter, Bajerovska, Lubica, Chabron, Miroslav, Dobias, Viliam, Havlikova, Eva, Horanova, Bozena, Kratochvilova, Renata, Kubova, Dana, Murgas, Jan, Patras, Juraj, Simak, Ladislav, Snarskij, Vladimir, Zaviaticova, Zuzana, Zuffova, Marcela, Roig, Francesc Escalada, Santos, Luis Sánchez, Sucunza, Alfredo Echarri, Cordero Torres, Juan A., Muñoz, Guadalupe Inza, del Valle, Marta Martínez, Rozalen, Isabel Ceniceros, Sánchez, Enrique Martín, Berlanga, María Victoria Raúl Canabal, Olalde, Karlos Ibarguren, Ruiz Azpiazu, José I., García-Ochoa, María José, López-Navarro, Rafael Zoyo, Adsuar Quesada, José M., Cortés Ramas, José A., Mellado Vergel, Francisco J., López Messa, Juan B., del Valle, Patricia Fernández, Anselmi, Luciano, Benvenuti, Breganzona Claudio, Batey, Nigel, Ambulance, Yorkshire, Booth, Scott, Bucher, Patricia, Deakin, Charles D., Duckett, Jay, Ji, Chen, Loughlin, Nancy, Lumley-Holmes, Jenny, Lynde, Jessica, Mersom, Frank, Ramsey, Carly, Robinson, Clare, Spaight, Robert, Dosanjh, Sukhdeep, Virdi, Gurkamal, Whittington, Andrew, Gräsner, Jan-Thorsten, Lefering, Rolf, Koster, Rudolph W., Masterson, Siobhán, Böttiger, Bernd W., Herlitz, Johan, Wnent, Jan, Tjelmeland, Ingvild B.M., Ortiz, Fernando Rosell, Maurer, Holger, Baubin, Michael, Mols, Pierre, HadžibegoviĿ, Irzal, Ioannides, Marios, Škulec, Roman, Wissenberg, Mads, Salo, Ari, Hubert, Hervé, Nikolaou, Nikolaos I., Lóczi, Gerda, Svavarsdóttir, Hildigunnur, Semeraro, Federico, Wright, Peter J., Clarens, Carlo, Pijls, Ruud, Cebula, Grzegorz, Correia, Vitor Gouveia, Cimpoesu, Diana, Raffay, Violetta, Trenkler, Stefan, Markota, Andrej, Strömsöe, Anneli, Burkart, Roman, Perkins, Gavin D., and Bossaert, Leo L.

Published
2016
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27. Efficacy and Safety of Methoxyflurane for Treatment of Acute Traumatic Pain by EMTs during Alpine Rescue Operations: The "PainDrop" Trial.

Author

Egger, Alexander, Huber, Tobias, Heschl, Stefan, Fiegl, Jakob, Burger, Josef, Trimmel, Helmut, Schreiber, Wolfgang, Niederer, Maximilian, Tscherny, Katharina, and Roth, Dominik

Subjects
INHALATION anesthetics, DRUG efficacy, FIELD research, PAIN, SCIENTIFIC observation, TRAFFIC accidents, PRE-tests & post-tests, TREATMENT effectiveness, T-test (Statistics), DESCRIPTIVE statistics, NATURE, DATA analysis software, PATIENT safety, PAIN management, ACUTE diseases, RESCUE work, LONGITUDINAL method, EVALUATION
Abstract

Background: Treatment of acute traumatic pain is a core task for mountain rescue services. Intravenous access, however, is often difficult, and the vast majority of missions are carried out without a physician at the scene. The spectrum of analgesics available for use by non-physician personnel is limited. Inhaled analgesics, such as methoxyflurane, might prove useful, but currently no data exist on their application by non-physicians in the alpine setting. Methods: This prospective observational alpine field study was conducted over a period of 15 months. Patients suffering traumatic injuries with moderate to severe pain (pain score ≥ 5) after downhill bike accidents in the Tyrol mountains (1,362 m to 2,666 m above sea level) were enrolled. Teams of four mountain rescue service members, one of them a trained EMT, treated the patients with 3 ml of methoxyflurane by inhaler. We measured efficacy as reduction in pain from baseline to 15 minutes after treatment on a numerical rating scale. Safety was assessed by change in vital signs or occurrence of side-effects. Sample-size calculations were based on the efficacy outcome and yielded a need for 20 patients at a power of 0.8. Results: From June 29, 2020 to September 30, 2021, a total of 20 patients (two females; mean age 37 years) were included. The mean initial pain score was 7.2 (SD 1.0) points. After 15 minutes, pain was significantly reduced by a mean of 2.9 (SD 1.4) points. No major adverse events or relevant changes in vital signs were observed. Conclusion: The use of methoxyflurane by EMTs during alpine rescue operations in our study proved to be safe and efficient. We observed no reduction in the efficacy of the inhaler device at moderate altitude. [ABSTRACT FROM AUTHOR]

Published
2023
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33. Landiolol in patients with septic shock resident in an intensive care unit (LANDI-SEP): study protocol for a randomized controlled trial

Author

Unger, Martin, Morelli, Andrea, Singer, Mervyn, Radermacher, Peter, Rehberg, Sebastian, Trimmel, Helmut, Joannidis, Michael, Heinz, Gottfried, Cerny, Vladimír, Dostál, Pavel, Siebers, Christian, Guarracino, Fabio, Pratesi, Francesca, Biancofiore, Gianni, Girardis, Massimo, Kadlecova, Pavla, Bouvet, Olivier, Zörer, Michael, Grohmann-Izay, Barbara, Krejcy, Kurt, Klade, Christoph, and Krumpl, Günther

Published
2018
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39. BMC Emergency Medicine / Usability and effectiveness of inhaled methoxyflurane for prehospital analgesia : a prospective, observational study

Author

Trimmel, Helmut, Egger, Alexander, Doppler, Reinhard, Pimiskern, Mathias, and Voelckel, Wolfgang G.

Subjects
Emergency medical service, Methoxyflurane, Prehospital pain management, Inhaled analgesia, Paramedics
Abstract

Background: Pain relief in the prehospital setting is often insufficient, as the administration of potent intravenous analgesic drugs is mostly reserved to physicians. In Australia, inhaled methoxyflurane has been in routine use by paramedics for decades, but experience in Central European countries is lacking. Thus, we aimed to assess whether user friendliness and effectiveness of inhaled methoxyflurane as sole analgesic match the specific capabilities of local ground and air-based EMS systems in Austria. Methods: Observational study in adult trauma patients (e.g. dislocations, fracture or low back pain following minor trauma) with moderate to severe pain (numeric rating scale [NRS] ≥4). Included patients received a Penthrop® inhaler containing 3 mL of methoxyflurane (maximum use 30 min). When pain relief was considered insufficient (NRS reduction < 3 after 10 min), intravenous analgesics were administered by an emergency physician. The primary endpoint was effectiveness of methoxyflurane as sole analgesic for transport of patients. Secondary endpoints were user friendliness (EMS personell), time to pain relief, vital parameters, side effects, and satisfaction of patients. Results: Median numeric pain rating was 8.0 (7.0–8.0) in 109 patients. Sufficient analgesia (reduction of NRS ≥3) was achieved by inhaled methoxyflurane alone in 67 patients (61%). The analgesic effect was progressively better with increasing age. Side effects were frequent (n = 58, 53%) but mild. User satisfaction was scored as very good when pain relief was sufficient, but fair in patients without benefit. Technical problems were observed in 16 cases (14.7%), mainly related to filling of the inhaler. In every fifth use, the fruity smell of methoxyflurane was experienced as unpleasant. No negative effects on vital signs were observed. Conclusion: In prehospital use, inhaled methoxyflurane as sole analgesic is effective for transport of trauma patients (62%) with moderate to severe pain. Older patients benefit especially from inhaled methoxyflurane. Side effects are mild and vital parameters unaffected. Thus, inhaled methoxyflurane could be a valuable device for non-physician EMS personnel rescue services also in the central Europe region.

Published
2022
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41. Volatile Anästhetika zur präklinischen Analgesie durch Rettungssanitäter – Eine Übersicht

Author

Trimmel, Helmut, Egger, Alexander, Doppler, Reinhard, Beywinkler, Christoph, Voelckel, Wolfgang G., and Kreutziger, Janett

Subjects
Medisinske Fag: 700::Klinisk medisinske fag: 750::Anestesiologi: 765 [VDP], paramedisin, prehospitale tjenester, anestesi, smertelindring
Abstract

Patienten mit Schmerzen können durch den nichtärztlichen Rettungsdienst mitunter nur inadäquat versorgt werden, da aufgrund rechtlicher Einschränkungen die Anwendung stark wirksamer Schmerzmittel (Opioide) bzw. ausbildungsbedingt eine i.v.-Therapie in Deutschland und Österreich oft nicht möglich ist. Häufig müssen Notärzte für schmerzgeplagte Patienten nachgefordert werden, wodurch deren Verfügbarkeit für z. B. vitale Notfälle reduziert sein kann. Inhalativ zu verabreichende Analgetika könnten hierfür eine interessante Alternative darstellen. Derzeit steht dazu in Deutschland und Österreich Lachgas (N2O, als Livopan® im Handel) zur Verfügung, eine Mischung aus jeweils 50 % Lachgas und Sauerstoff. In Österreich ist seit 2018 auch Methoxyfluran (Penthrop®) zur Behandlung mäßiger bis starker Schmerzen nach einem Trauma für die prä- und innerklinische Anwendung bei Erwachsenen zugelassen. In der Zusammenschau der vorhandenen Literatur, jahrzehntelanger Erfahrung in der Anwendung der Sauerstoff-Lachgas-Mischung im angloamerikanischen Bereich und von inhalativem Methoxyfluran v. a. in Australien sowie aktuellen Studien aus Europa kann gefolgert werden, dass diese bei Einhaltung der Anwendungsvorschriften effektiv, sicher und nebenwirkungsarm sind. Dies bestätigt auch eine eigene Untersuchung zu Methoxyfluran im präklinischen Einsatz. Die Anwendung von Lachgas ist aufgrund des Druckgaszylinders von der Handhabung her etwas aufwendig; Methoxyfluran ist einfacher anzuwenden und bei starken Schmerzen auch wirksamer. Die Zulassung von Methoxyfluran ist jedoch auf Erwachsene beschränkt, wo es mit zunehmendem Alter deutlich besser wirkt. Der Einsatz von Lachgas und insbesondere Methoxyfluran könnte aufgrund der Datenlage wie auch eigener Erfahrungen für rettungsdienstliches Fachpersonal nach entsprechender Einweisung empfohlen werden. Treatment of acute pain is a central task in emergency medicine. Yet, prehospital pain relief is often insufficient or delayed since the administration of potent intravenous analgesic drugs (such as opioids) is mostly limited to physicians due to legal restrictions or training deficiencies in Germany and Austria. Frequently, prehospitally operating emergency physicians have to be demanded later for anguished patients limiting disposability of physicians for patients who are in a potentially life-threatening condition. Thus, inhaled analgesics could represent an interesting alternative. A mixture of 50% nitrous oxide and 50% oxygen (N2O, Livopan®) has been available in Germany and Austria for several years; however, prehospital use of Livopan has been merely realized and only one trial has been published. In addition, methoxyflurane (Penthrop®), a volatile anesthetic from the group of the dialkyl esters (2-dichloro-1:1-difluoroethyl-methyl-ester) was approved for the treatment of moderate to severe pain following trauma in adults in many European countries in recent years and was brought onto the market in Austria in 2018. Several in-hospital trials demonstrated high effectiveness in this setting. This article discusses the effects and prehospital areas of application of both substances in the light of the existing literature. We provide a narrative overview of the current study situation and report on a recently performed prehospital application study of methoxyflurane (Penthrop®) from Austria. The need for pressurized gas cylinders for the use of N2O represents a certain limitation in prehospital use. Furthermore, in certain injuries such as of the inner ear or a pneumothorax N2O should not be used and the risk of diffusion hypoxemia has to be addressed. Users should be particularly careful and limit the use in alcohol addicts and vegans. The advances of N2O are that it is odorless, has a fast onset of action, the usability in patients over 1 month old and has stabilizing effects on the circulation. Plenty of literature regarding prehospital as well as in-hospital use of nitrous oxide in emergency, obstetric and pediatric settings show its effectiveness as a single drug as well as in combination with other analgesics, such as paracetamol or various opioids. Its long tradition in Anglo-American countries is also based on its safety and low rate of side effects. Methoxyflurane is easier to store and handle and may be slightly more effective in severe pain after trauma; however, its approval is restricted to adults, where it works significantly better with increasing age, based on the declining minimal alveolar concentration (MAC) of all inhaled anesthetics with increasing age. Furthermore, decades of use of inhaled methoxyflurane in Australia have shown the drug is effective, safe and low in side effects and has a broad spectrum of applications. The use of methoxyflurane is limited in patients with severe hepatic or renal insufficiency and the characteristic odor has been described as unpleasant by some patients. In Europe, three large in-hospital trials showed strong pain relief in trauma patients, even comparable to opioids. Overall, based on the current evidence, the use of nitrous oxide and even more of methoxyflurane may be recommended also for prehospital use by skilled paramedics.

Published
2021

44. To ventilate or not to ventilate during bystander CPR — A EuReCa TWO analysis

Author

Wnent, Jan, primary, Tjelmeland, Ingvild, additional, Lefering, Rolf, additional, Koster, Rudolph W., additional, Maurer, Holger, additional, Masterson, Siobhán, additional, Herlitz, Johan, additional, Böttiger, Bernd W., additional, Ortiz, Fernando Rosell, additional, Perkins, Gavin D., additional, Bossaert, Leo, additional, Moertl, Maximilian, additional, Mols, Pierre, additional, Hadžibegović, Irzal, additional, Truhlář, Anatolij, additional, Salo, Ari, additional, Baert, Valentine, additional, Nagy, Eniko, additional, Cebula, Grzegorz, additional, Raffay, Violetta, additional, Trenkler, Stefan, additional, Markota, Andrej, additional, Strömsöe, Anneli, additional, Gräsner, Jan-Thorsten, additional, Alihodžić, Hajriz, additional, Ioannides, Marios, additional, Wissenberg, Mads, additional, Escutnaire, Josephine, additional, Nikolaou, Nikolaos, additional, Jonsson, Bergthor Steinn, additional, Wright, Peter, additional, Semeraro, Federico, additional, Clarens, Carlo, additional, Beesems, Steffie, additional, Correia, Vitor H., additional, Cimpoesu, Diana, additional, Burkart, Roman, additional, Booth, Scott, additional, Baubin, Michael, additional, Schinnerl, Adolf, additional, Prause, Gerhard, additional, Tschoellitsch, Thomas, additional, Trimmel, Helmut, additional, Belz, Rene, additional, Fleischmann, Wolfgang, additional, Bartiaux, Magali, additional, Monsieurs, Koenraad, additional, Wilmin, Stephan, additional, Faniel, Mathias, additional, Vanhove, Marie, additional, Lievens, Pascale, additional, Biarent, Dominique, additional, Van Nuffelen, Marc, additional, Hubloue, Ives, additional, Jacques, Jean-Marie, additional, Yerna, Michèle, additional, Leach, Robert, additional, Jeanmaire, Mathieu, additional, Denoël, Paule, additional, Van Trimpont, Frank, additional, Desmet, Francis, additional, Delhaye, Louise, additional, Van Belleghem, Vincent, additional, Dewitte, Ken, additional, Abbasi, Musa, additional, Scheyltjens, Simon, additional, Vermylen, 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Published
2021
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49. S(+)-ketamine

Author

Trimmel, Helmut, Helbok, Raimund, Staudinger, Thomas, Jaksch, Wolfgang, Messerer, Brigitte, Schöchl, Herbert, and Likar, Rudolf

Subjects
Critical care, Emergency medicine, Ketamine, Review Article, Analgesia, Neuroprotection
Abstract

Summary S(+)-ketamine, the pure dextrorotatory enantiomer of ketamine has been available for clinical use in analgesia and anesthesia for more than 25 years. The main effects are mediated by non-competitive inhibition of the N-methyl-D-aspartate (NMDA) receptor but S(+)-ketamine also interacts with opioid receptors, monoamine receptors, adenosine receptors and other purinergic receptors. Effects on α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, metabotropic glutamate receptors (mGluR) and L‑type calcium chanels have also been described. S(+)-ketamine stimulates the sympathetic nerve system, making it an ideal drug for analgosedation or induction of anesthesia in instable patients. In addition, the neuroprotective properties, bronchodilatory, antihyperalgesic or antiepileptic effects provide interesting therapeutic options. In this article we discuss the numerous effects of S(+)-ketamine under pharmacological and clinical aspects especially for typical indications in emergency medicine as well as intensive care.

Published
2018

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