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Der Begriff der sog. „Rettungskette“ beschreibt die praklinische Versorgung von Notfallpatienten als ein zeitliches, idealerweise reibungsloses Ineinandergreifen von Einzelschritten, so dass damit eine bestmogliche Versorgung gewahrleistet werden kann. Insgesamt hangt die Qualitat der Versorgung dabei von der „Starke“ jedes einzelnen Gliedes der Rettungskette ab (⊡ Abb. 1.1).

Im Rettungsdienst werden unter dem Begriff „Hygiene“ alle vorsorglichen Vorkehrungen und Masnahmen zusammengefasst, die alle im Krankentransport und Rettungsdienst Tatigen, sowie die zu betreuenden Patienten, vor schadlichen und krankmachenden Einflussen durch Mikroorganismen schutzen sollen.

INTRODUCTION: The aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.METHODS: This was an international, pr ...

Background Early repolarization patterns (ERP) have been found to be associated with poor cardiovascular end points. We aimed to evaluate the ERP prevalence among patients with structurally normal hearts undergoing radiofrequency (RF) pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) ablation and its association with the AF recurrence. Methods All consecutive patients who underwent RF-PVI as index procedure for paroxysmal AF in our center were evaluated. Exclusion criteria: structural heart disease, ongoing use of Class I/III antiarrhythmics, complete-bundle-branch-block. Lateral (I, aVL, V-5-V-6), inferior (II, III, aVF), or infero-lateral (both) ERP were defined in baseline ECG as horizontal/downsloping J-point elevation >= 1 mm in two consecutive leads with QRS slurring/notching. Documented episodes of AF lasting >= 30 s were considered recurrence. Results Of 701 cases, 434 patients (305 males, 58 +/- 11 years) were included for analysis. ERP observed in 67 patients (15.4%) (Infero-lateral n = 26, inferior n = 23, lateral n = 18) which were significantly younger, demonstrating longer PR-interval and lower heart rates. At a mean follow-up of 22.1 +/- 9.7 months, AF recurrences were found in 107 patients (24.6%). In middle-aged patients (>= 40-n = 206, 79% male), those with an infero-lateral ERP had higher recurrence compared with the ones without (56.3% vs. 19%; p = 0.002). Infero-lateral ERP was significantly predicting recurrence (HR 2.42, 95% CI 1.21-4.82; p = 0.01). Conclusion Early repolarization patterns was more prevalent in our AF population than in the general population. Infero-lateral ERP in baseline ECG might predict AF recurrence in the follow-up after RF-PVI in middle-aged patients.

AIMS: Real Time Recordings (RTR) of pulmonary vein (PV) activity provide important information in the setting of the 2nd generation Cryoballoon (CB-A), as a funcion of time to isolation. Visualization of RTR with the standard inner lumen mapping catheter (ILMC) 20mm Achieve (AC) is possible in roughly 50% of PVs. A novel 25mm-Achieve Advance (AC-A) has been developed with the aim of increasing the detection of RTR. The purpose of this study is to compare the AC-A with the AC, to feasibility and improvement of RTR. METHODS: We assigned 50 patients with paroxysmal or persistent atrial fibrillation to CB-A PVI, using the AC-A as ILMC. We compared this group with 50 patients, matched for age and left atrial volume, who previously underwent the CB-A PVI using the AC. RESULTS: RTR were more frequently observed with the AC-A than with the AC (74% vs 49%; p= 0.02). RTR in the left superior PVs was similar in both groups (74% vs 72%, p= 0.8). RTR with the AC-A were equally appreciated in left or right sided, superior or inferior PVs. No significant differences were found in terms of feasibility, procedure fluoroscopy and freezing times, nadir temperatures, and acute PVI. CONCLUSIONS: CB-A PVI with the AC-A is feasible and safe in all PVs. The AC-A has proven significantly superior in visualising RTR if compared to the AC, affording RTR in 74% of PVs., Aims: Real Time Recordings (RTR) of pulmonary vein (PV) activity provide important information in the setting of the 2nd generation Cryoballoon (CB-A), as a funcion of time to isolation. Visualization of RTR with the standard inner lumen mapping catheter (ILMC) 20mm Achieve (AC) is possible in roughly 50% of PVs. A novel 25mm-Achieve Advance (AC-A) has been developed with the aim of increasing the detection of RTR. The purpose of this study is to compare the AC-A with the AC, to feasibility and improvement of RTR. Methods: We assigned 50 patients with paroxysmal or persistent atrial fibrillation to CB-A PVI, using the AC-A as ILMC. We compared this group with 50 patients, matched for age and left atrial volume, who previously underwent the CB-A PVI using the AC. Results: RTR were more frequently observed with the AC-A than with the AC (74% vs 49%; p= 0.02). RTR in the left superior PVs was similar in both groups (74% vs 72%, p= 0.8). RTR with the AC-A were equally appreciated in left or right sided, superior or inferior PVs. No significant differences were found in terms of feasibility, procedure fluoroscopy and freezing times, nadir temperatures, and acute PVI. Conclusions: CB-A PVI with the AC-A is feasible and safe in all PVs. The AC-A has proven significantly superior in visualising RTR if compared to the AC, affording RTR in 74% of PVs.

AIMS: The third-generation Cryoballoon Advance Short-tip (CB-ST) has been designed with a 40% shortened tip length compared with the former second-generation CB Advance device. Ideally, a shorter tip should permit an improved visualization of real-time (RT) recordings in the pulmonary vein (PV) due to a more proximal positioning of the inner lumen mapping catheter. In the present study, we sought to analyse the rate of visualization of RT recordings in our first series of patients with the CB-ST device. METHODS AND RESULTS: All consecutive patients having undergone CB ablation using CB-ST technology were analysed. Exclusion criteria were the presence of an intracavitary thrombus, uncontrolled heart failure, moderate or severe valvular disease, and contraindications to general anaesthesia. A total of 60 consecutive patients (60.5 ± 11.2 years, 62% males) were evaluated. Real-time recordings were detected in 209 of 240 PVs (87.1%). Specifically, RT recordings could be visualized in 55 left superior PVs (91.7%), 51 left inferior PVs (85.0%), 53 right superior PVs (88.3%), and 50 right inferior PVs (83.3). CONCLUSION: The rate of visualization of RT recordings is significantly high during third-generation CB-ST ablation. Real-time recordings can be visualized in ∼87.1% of veins with this novel cryoballoon.

An editorial written by Fritz Stertz et al. in 2002 and pubished in this journal was one of the first to highlight concerns bout the introduction of a new European Union (EU) clinical trils directive (Clinical Trials Directive 2001/20/EC) particularly for esearch in emergency settings.1 The directive sought “to simplify nd harmonize the administrative provisions governing clinical rials in the European Community, by establishing a clear, transarent procedure for conducting studies involving investigational edicinal products”. It is widely acknowledged that the Directive rought inunnecessary administrative and regulatoryburdens. The nflexibility of the Directive led to individual countries creating ocal legislation in an attempt to facilitate emergency research, hich increasedvariationbetweencountries, andaddeddelays and ncreased costs for researchers.2 A group of clinicians, ethicists and awyers (the ‘Vienna Initiative to save European Research’ (VISEAR) nvestigators) produced a consensus document to promote a unied approach to local legislation,3 although the recommendations ere never fully implemented. The EU announced its intent to revise the Clinical Trials Direcive 2001/20/EC in July 2012.4 The consultation paper draws pecific attention to research in patients without capacity statng: “Regarding clinical trials in emergency situations, Directive 001/20/EC does so far not address the specific situation where, ecause of the urgency of the situation, it is impossible to obtain ree and informed consent from the subject or the legal repreentative (‘clinical trials in emergency situations’). To address this, pecific provisions on clinical trials in emergency situations have een added in linewith existing international guidance documents n this issue.”

With respect to a radial arterial pressure measurement, a more central achievement of this pressure should improve the reliability of endotracheal bioimpedance cardiac output (CO) monitoring. We therefore compared prospectively the impact on accuracy of this device, in comparison with thermodilution (TD) CO.