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Context: Automated verbal and visual feedback improves quality of resuscitation in out-of-hospital cardiac arrest and was proven to increase short-term survival. Quality of resuscitation may be hampered in more difficult situations like emergency transportation. Currently there is no evidence if feedback devices can improve resuscitation quality during different modes of transportation., Objective: To assess the effect of real time automated feedback on the quality of resuscitation in an emergency transportation setting., Design: Randomised cross-over trial., Setting: Medical University of Vienna, Vienna Municipal Ambulance Service and Helicopter Emergency Medical Service Unit (Christophorus Flugrettungsverein) in September 2007., Participants: European Resuscitation Council (ERC) certified health care professionals performing CPR in a flying helicopter and in a moving ambulance vehicle on a manikin with human-like chest properties., Interventions: CPR sessions, with real time automated feedback as the intervention and standard CPR without feedback as control., Main Outcome Measures: Quality of chest compression during resuscitation., Results: Feedback resulted in less deviation from ideal compression rate 100 min(-1) (9+/-9 min(-1), p<0.0001) with this effect becoming steadily larger over time. Applied work was less in the feedback group compared to controls (373+/-448 cm x compression; p<0.001). Feedback did not influence ideal compression depth significantly. There was some indication of a learning effect of the feedback device., Conclusions: Real time automated feedback improves certain aspects of CPR quality in flying helicopters and moving ambulance vehicles. The effect of feedback guidance was most pronounced for chest compression rate., (Copyright 2009 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To examine to what extent the type of emergency medical transportation influences the physical response of advanced life support providers., Background: Providing external chest compression during resuscitation is physically exhausting. If the decision is made to bring the patient to a hospital undergoing resuscitation procedures, there are usually two options for transportation: ambulance vehicles or helicopters. There should be discussion on deciding which means of transportation should be preferred, because there is evidence that the quality of rescuers performance influences patient's outcome., Methods: The study was a randomised crossover trial comparing physical strain on 11 European Resuscitation Council (ERC) approved healthcare professionals during external chest compression in different environments: (a) moving ambulance vehicle vs. (b) flying helicopter, and both compared to (c) staying at the scene (control)., Main Outcome Measures: Difference in heart rate to systolic blood pressure ratio after 8 min of external chest compression. Secondary outcomes were BORG-rate of perceived exertion scale, blood pressure, serum lactate, and a Nine Hole Peg Test., Results: Mean heart rate to systolic blood pressure ratio was 0.89+/-0.21 in the ambulance vehicle compared to 1.01+/-0.21 in the flying helicopter (p=0.04) There were no significant differences in the secondary outcome parameters. Perceived exertion increased by resuscitation time in all groups., Conclusion: External chest compression CPR is possible in a flying helicopter as it is in a moving ambulance vehicle. There is no clinical relevant difference in physical strain during ALS between a flying helicopter and a moving ambulance car. As would be expected, the exertion increases with duration of CPR.

Background: No accurate, independent biomarker has been identified that could reliably predict neurological outcome early after cardiac arrest. We speculated that brain natriuretic peptide (BNP) measured at hospital admission may predict patient outcome., Methods: BNP-levels were measured in 155 comatose cardiac arrest survivors (108 male, 58 years [IQR 49-68]) (median time to ROSC 11min; IQR 20-30) during a 6-year study period. Cardiovascular co-morbidities and resuscitation history were assessed according to the Utstein-style and patients were followed for 6-month neurological outcome measured by cerebral performance category (CPC) and survival., Results: Seventy patients (45%) suffered from unfavourable neurological outcome and 79 deaths (51%) occurred during the first 6 months. BNP was significantly associated with an adverse neurological outcome and mortality, independent of the prearrest health condition and cardiac arrest characteristics (median 60 pg/ml; IQR 10-230). Adjusted odds ratios for poor neurological outcome at 6 months were 1.14 (95% CI 0.51-2.53), 1.76 (95% CI 0.80-3.88) and 2.25 (95% CI 1.05-4.81), for increasing quartiles of BNP as compared to the lowest quartile. Adjusted odds ratios for mortality until 6 months were 1.09 (95% CI 0.35-3.40), 2.81 (0.80-9.90) and 4.7 (1.27-17.35) compared to the lowest quartile, respectively., Conclusion: Brain natriuretic peptide levels on admission predict neurological outcome at 6 months and survival after cardiac arrest.

Context: Transport of patients during resuscitation is a critical procedure. In both, ambulances and helicopters the quality of resuscitation is potentially hampered due to the movement of the vehicle and confined space. To date, however, no direct comparison of the quality of resuscitation at the scene, during a helicopter flight and in a moving ambulance has been made., Objective: Direct comparison of the quality of resuscitation at the scene, during a helicopter flight and in a moving ambulance., Design: The study was performed in July 2005 as a randomised cross-over trial comparing different environments for resuscitation., Setting: Medical University of Vienna., Participants: Eleven European Resuscitation Council (ERC) approved health care professionals., Interventions: Interventions during resuscitation: (a) in a moving ambulance, (b) in a flying helicopter, were compared to those staying at the (c) scene (control). Each participant performed resuscitation in all three environments., Main Outcome Measures: Quality of chest compression during resuscitation., Results: Compared to resuscitation at the scene, efficiency of chest compressions during a helicopter flight was 86% and 95% in the moving ambulance 95%. There were no differences in secondary outcomes (time without chest compression, total number of incorrect hand position relative to total compressions, and total number of incorrect pressure release relative to total compressions)., Conclusions: Resuscitation during transport is feasible and relatively efficient. There is some difference between the environments, but there is no relevant difference between helicopters and ambulances regarding the effectiveness of CPR.

Background: Mass media deliver pertinacious rumours that lunar phases influence the progress and long-term results in several medical procedures. Peer reviewed studies support this, e.g. in myocardial infarction, others do not., Methods: We looked retrospectively at the dates of cardiac arrests (CA; n=368) of cardiac origin and of acute myocardial infarctions (AMI) with consecutive thrombolytic therapy or acute PTCA (n=872) and at the lunar phases at the corresponding dates. Medical data had been collected prospectively on the patient's admission. The lunar phases were defined as full moon+/-1 day, new moon+/-1 day and the days in between as waning and waxing moon. The incidence of these cardiac events at each phase was calculated as days with a case divided by the total number of days of the specific moon phase in the observation period (1992-1998). Wilcoxon Rank Test was used for statistical analysis., Results: AMI and CA occurred on equal percentages of days within each lunar phase: AMI on 35% of all days with new moon, on 38% of full moon days, on 39% waning, and on 41% of the waxing moon days; CA on 19, 17, 16 and 16% of all days of the respective lunar phase. This difference was not significant., Conclusion: Lunar phases do not appear to correlate with acute coronary events leading to myocardial infarction or sudden cardiac death.

Objectives: The recurrence rate of lethal cardiac events after the survival of a primary cardiac arrest in patients not having received an implantable cardioverter defibrillator (ICD) is investigated., Background: According to current guidelines, only a small percentage of patients after successful cardiopulmonary resuscitation due to an underlying cardiac problem are eligible for the implantation of an ICD., Methods: For retrospective analysis, we used a data registry of patients admitted to an emergency department after cardiac arrest. Patients who had a primary cardiac cause for their cardiac arrest and who did not die within the first month after successful restoration of spontaneous circulation were selected., Results: From 1246 patients, 360 met the inclusion criteria. A second lethal cardiac event occurred in 94 (26%). Of those 94 patients, 57 (61%) had good neurological function before their second cardiac arrest. Of the survivors with good neurological function, 47 (82%) did not have an ICD or a cardiac transplant. Another cardiac arrest due to a primary cardiac event occurred in 34 (72%) of these patients., Conclusions: Cardiac arrest survivors without an apparent indication for an ICD have a high risk of suffering from a re-arrest of cardiac origin.

Objective: Physical exhaustion is a frequent condition in emergency medical teams after in-house emergency runs, which might affect the quality of advanced care. Newly available light-weight scooters may reduce exertion as measured by the cardiovascular response in these circumstances and, therefore, may reduce physical exhaustion on arrival., Methods: We undertook a randomised cross-over trial in a simulated in-house emergency alarm run to examine the influence of scooting compared with conventional running on pulse rate (primary outcome), manual skillfulness and response time., Results: We tested 24 emergency department professionals in eight emergency medical teams. After scooting the pulse rate was significantly lower compared with conventional running [157 (IQR 145-169) vs. 170 (IQR 154-175) min(-1), P=0.004]. After the simulated emergency alarm run no difference was found in manual skillfulness and response time between scooting and running., Conclusion: Using scooters for simulated in-house emergency alarm runs markedly reduces the cardiovascular response of emergency medical teams.