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Zusammenfassung Ziel der Studie Aus dem Vergleich der bestehenden Erfahrungen von Kindernotärzten und Nichtkindernotärzten sollen Rückschlüsse auf das optimale Vorgehen am Einsatzort und auf mögliche Ausbildungsschwerpunkte gezogen werden. Methodik Die Datenerhebung erfolgte anhand eines Online-Fragebogens. Ergebnisse Die Kindernotärzte hatten häufiger bereits eine Thoraxdekompression beim Kind durchgeführt (67,7% vs. 14,4%, p Schlussfolgerung Zwischen den beiden Gruppen bestehen signifikante Unterschiede in Bezug auf die gemachte Erfahrung und das gewählte Vorgehen, aus denen Rückschlüsse auf Ausbildungsinhalte und möglicherweise auch Empfehlungen für das praktische Vorgehen gezogen werden können.

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.

BackgroundPain management in the prehospital setting remains a particular challenge for paramedics and emergency physicians, especially in children. This study evaluates the prehospital use and effect of analgesics in children with trauma or severe disease. MethodsThis study is a retrospective analysis of the database of a German air rescue service and was conducted over a period of 9 years (2012 – 2020) to assess pain in general and whether patients with trauma or severe disease received treatment with analgesics. We included all patients in the registry under the age of 16 years. Patients with a Glasgow Coma Scale of 3 at hospital admission and incomplete records were excluded. The intensity of pain was determined by the emergency physician on scene at arrival and hospital admission in a ten-point rating scale (0=no pain). Effective pain reduction was analyzed. ResultsOut of 227,458 cases, a total of 22,025 emergency cases involved pediatric patients aged 0 – 16 years. 20,407 cases were included in the study. 12,000 (58,8%) children had suffered a trauma, 8,108 (39,7%) had severe diseases and 297 (1,5%) had both. In total, 4,608 (38,4%) of the children with trauma were assessed having a numerical rating scale (NRS) > 4 at EMS arrival. These patients received mainly ketamine (34.5%) and the opioids fentanyl (38.7%) and piritramide (19.1%). The value on the NRS was significantly lower at admission to hospital (mean 1.9) compared with the EMS arrival (mean 6.9). In 4.9% the NRS at hospital admission was still >4. 282 patients had a disease with an initially pain determined >4. The pain therapy consisted of opioids (35.8%) and ketamine (2.8%). 28.4% patients in the disease group received no pain medication. In 16.0% the NRS at hospital admission was still >4.ConclusionsGerman emergency physicians achieved a sufficient pain therapy in pediatric patients with a NRS >4 after trauma. In case of a disease the pain management by the emergency physicians is restrained and less successful. The most common analgesic medications administered were ketamine and fentanyl, followed by piritramide. Trial registration: The study has been retrospectively registered at DRKS (DRKS00026222)

ZusammenfassungDas innerklinische Notfallmanagement ist ein zentraler Baustein für die Patientensicherheit im Krankenhaus. Durch Frühwarnsysteme und die Etablierung Medizinischer Einsatzteams (MET) können sich verschlechternde Patienten frühzeitig erkannt und vermeidbare Todesfälle verhindert werden. Dieser Beitrag stellt wesentliche Elemente eines modernen innerklinischen Notfallmanagements dar.

ZusammenfassungDie Zukunft der Notfallmedizin wird wesentlich durch technische Innovationen bestimmt werden: Neben einer virtuellen Lernumgebung im Rahmen der Ausbildung wird vor allem die Erkennung des Herz-Kreislauf-Stillstandes in Zukunft zunehmend digitalisiert werden. Der größte Meilenstein aber wird die individualisierte Reanimation sein – möglicherweise bestimmt schon bald der Computer stärker den Ablauf der Reanimation als standardisierte Algorithmen.

According to the current resuscitation guidelines, the use of mechanical chest compression devices could be considered under special circumstances like transport with ongoing resuscitation or long-term resuscitation. The aim of this study was to investigate whether survival is improved using mechanical devices under such circumstances.Out-of-hospital cardiac arrests from all high-quality data centres of the German Resuscitation Registry from 2007 to 2020 were investigated. The use of mechanical devices was compared separately for transport with ongoing resuscitation, prolonged resuscitation (45 min), and resuscitation with fibrinolytic agents applied. Baseline characteristics, 30-day survival/discharged alive, and neurological function at discharge were analysed descriptively; and 30-day survival/discharged alive was additionally analysed using multivariate logistic regression.Overall, patients who were treated with a mechanical device tended to be younger and were significantly more likely to have a witnessed cardiac arrest and a shockable initial rhythm. During the study period, 4,851 patients were transported to hospital with ongoing resuscitation (devices used in 44.2%). The 30-day survival was equal (odds ratio, OR: 1.13, 95%-CI: 0.79-1.60). In 3,920 cases, a resuscitation duration 45 min was documented (9.5% with device). When a device was used, 30-day survival was significantly increased (OR 2.33, 95%-CI: 1.30-4.15). Fibrinolytic agents were used in 2,106 patients (22.2% with device). Here, 30-day survival was significantly worse with a device (OR: 0.52, 95%-CI: 0.30-0.91).Mechanical devices are not associated with better survival when used during transport, but rescuer safety could still be an important argument for their use. Devices are associated with better survival in prolonged resuscitation, but worse survival when a fibrinolytic was used.

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.

The aim of this study was to develop a score to predict the outcome for patients brought to hospital following out-of-hospital cardiac arrest (OHCA).All patients recorded in the German Resuscitation Registry (GRR) who suffered OHCA 2010-2017, who had ROSC or ongoing CPR at hospital admission were included. The study population was divided into development (2010-2016: 7985) and validation dataset (2017: 1806). Binary logistic regression analysis was used to derive the score. The probability of hospital discharge with good neurological outcome was defined as 1/(1 + eThe following variables were found to have a significant positive (+) or negative (-) impact: age 61-70 years (-0·5), 71-80 (-0·9), 81-90 (-1·3) and = 91 (-2·3); initial PEA (-0·9) and asystole (-1·4); presumable trauma (-1·1); mechanical CPR (-0·3); application of adrenalin 0 - 2 mg (-1·1), 2 - 4 mg (-1·6), 4 - 6 mg (-2·1), 6 - 8 mg (-2·5) and = 8 mg (-2·8); pre emergency status without previous disease (+0·5) or minor disease (+0·2); location at nursing home (-0·6), working place/school (+0·7), doctor's office (+0·7) and public place (+0·3); application of amiodarone (+0·4); hospital admission with ongoing CPR (-1·9) or normotension (+0·4); witnessed arrest (+0·6); time from collapse until start CPR 2 - 10 min (-0·3) and = 10 min (-0·5); duration of CPR5 min (+0·6). The AUC in the development dataset was 0·88 (95% CI 0·87-0·89) and in the validation dataset 0·88 (95% CI 0·86-0·90).The CaRdiac Arrest Survival Score (CRASS) represents a tool for calculating the probability of survival with good neurological function for patients brought to hospital following OHCA.

Background The effect of mechanical CPR is diversely described in the literature. Different mechanical CPR devices are available. The corpuls cpr is a new generation of piston-driven devices and was launched in 2015. The COMPRESS-trial analyzes quality of chest compression and CPR-related injuries in cases of mechanical CPR by the corpuls cpr and manual CPR. Methods This article describes the design and study protocol of the COMPRESS-trial. This observational multi-center study includes all patients who suffered an out-of-hospital cardiac arrest (OHCA) where CPR is attempted in four German emergency medical systems (EMS) between January 2020 and December 2022. EMS treatment, in-hospital-treatment and outcome are anonymously reported to the German Resuscitation Registry (GRR). This information is linked with data from the defibrillator, the feedback system and the mechanical CPR device for a complete dataset. Primary endpoint is chest compression quality (complete release, compression rate, compression depth, chest compression fraction, CPR-related injuries). Secondary endpoint is survival (return of spontaneous circulation (ROSC), admission to hospital and survival to hospital discharge). The trial is sponsored by GS Elektromedizinische Geräte G. Stemple GmbH. Discussion This observational multi-center study will contribute to the evaluation of mechanical chest compression devices and to the efficacy and safety of the corpuls cpr. Trial registration DRKS, DRKS-ID DRKS00020819. Registered 31 July 2020.

The preclinical treatment of a traumatic or spontaneous tension pneumothorax remains a particular challenge in pediatric patients. Currently recommended interventions for decompression are either finger thoracostomy or needle decompression. Due to the tiny intercostal spaces, finger thoracostomy may not be feasible in small children and surgical preparation may be necessary. In needle decompression, the risk of injuring underlying vital structures is increased because of the smaller anatomic structures. As most emergency physicians do not regularly work in pediatric trauma care, decompression of tension pneumothorax is associated with significant uncertainty; however, in this rare emergency situation, consistent and goal-oriented action is mandatory and lifesaving. An assessment of pre-existing experience and commonly used techniques therefore seems necessary to deduce the need for future education and training.In this study an online survey was created to evaluate the experience and the favored prehospital treatment of tension pneumothorax in children among German emergency physicians.An online survey was conducted with 43 questions on previous experience with tension pneumothorax in children, favored decompression technique and anatomical structures in different age groups. Surveyed were the emergency physicians of the ground-based emergency medical service of the University Medical Center Mannheim, the German Air Rescue Service (DRF) and the pediatric emergency medical service of the City of Munich.More than half of all respondents stated that there was uncertainty about the procedure of choice. Needle decompression was favored in smaller children and mini-thoracostomy in older children. In comparison with the literature, the thickness of the chest wall was mostly estimated correctly by the emergency medical physicians. The depth of the vital structures was underestimated at most of the possible insertion sites in all age groups. At the lateral insertion sites on the left hemithorax, however, the distance to the left ventricle was overestimated. The caliber of the needle selected for decompression tended to be too large, especially in younger children.Even though having interviewed an experienced group of prehospital emergency physicians, the experience in decompression of tension pneumothorax in children is relatively scant. Knowledge of chest wall thickness and depth to vital structures is sufficient, the choice of needle calibers tends to be too large but still reasonable. For many providers a large amount of uncertainty about the right choice of technique and equipment arises from the challenge of decompressing a tension pneumothorax in children and therefore further theoretical education and regular training are required for safe performance of the procedure.HINTERGRUND: Die präklinische Therapie des Spannungspneumothorax stellt bei pädiatrischen Patienten eine besondere Herausforderung dar. Da die meisten Notärzte nicht im Bereich der Kinder- und Jugendmedizin tätig sind, ist die Durchführung einer Entlastungspunktion in dieser Altersklasse dementsprechend mit einer größeren Unsicherheit verbunden. Gerade in dieser seltenen Einsatzsituation ist aber konsequentes und zielgerichtetes Handeln lebensrettend.Diese Studie untersucht das therapeutische Vorgehen von Notärzten bei einem Spannungspneumothorax bei Kindern im Alter von 1, 5 und 10 Jahren und evaluiert die Expertise für die empfohlenen Verfahren.Für diese Untersuchung wurde eine Online-Umfrage mit 43 Fragen zu den Themen Erfahrung, Durchführung und Anatomie in unterschiedlichen Altersgruppen durchgeführt. Befragt wurden die Notärzte des bodengebundenen Notarztdiensts der Universitätsmedizin Mannheim, der DRF Stiftung Luftrettung (DRF) und eines Kinder-Notarzteinsatzfahrzeugs der Landeshauptstadt München.Mehr als die Hälfte aller Befragten gab an, dass Unsicherheit über das Verfahren der Wahl bestehe. Bei kleineren Kindern wird von den Teilnehmern die Durchführung einer Nadeldekompression, bei größeren Kindern die Minithorakotomie bevorzugt. Im Vergleich mit der Literatur wurde die Dicke der Brustwand relativ gut eingeschätzt. Die Tiefe der vitalen Strukturen wurde in allen Altersklassen tendenziell eher unterschätzt. Im Bereich des 4./5. Interkostalraums in der vorderen Axillarlinie wurde der Abstand zu vitalen intrathorakalen Strukturen jedoch mitunter überschätzt. Die für die Dekompression ausgewählten Nadeln waren tendenziell eher etwas großkalibrig, jedoch noch innerhalb der aktuellen Empfehlungen.Aufgrund der geringen Vorerfahrung ist zur sicheren Anwendung der Entlastungspunktion bei Kindern neben der Kenntnis der Topographie auch ein regelmäßiges Training erforderlich.

Traumatisch bedingte Todesfalle sind nicht nur ein relevantes medizinisches, sondern auch ein soziookonomisches Problem. Dabei gehort die Versorgung eines polytraumatisierten Patienten zu eher selten vorkommenden Einsatzen im Rettungs- und Notarztdienst. Ziel dieser Arbeit ist der Vergleich von Gemeinsamkeiten und Unterschieden verschiedener Kurskonzepte und Leitlinien bezuglich der Behandlung des traumatischen Herz-Kreislauf-Stillstands („traumatic cardiac arrest“, TCA) mit der Zielsetzung, die Schwerpunkte jedes Konzepts herauszufiltern. Aufgrund der Herangehensweise bei der Versorgung eines polytraumatisierten Patienten existieren entscheidende Unterschiede zwischen dem traumatisch-bedingten Herz-Kreislauf-Stillstand und Herz-Kreislauf-Stillstanden anderer Ursachen.

The structure of emergency care is a key element for patients' safety in hospital. Early warning scores and the implementation of medical emergency teams (MET) can help to detect deteriorating patients early and prevent unexpected deaths. This article summarizes essential elements of a modern emergency management in hospitals.Das innerklinische Notfallmanagement ist ein zentraler Baustein für die Patientensicherheit im Krankenhaus. Durch Frühwarnsysteme und die Etablierung Medizinischer Einsatzteams (MET) können sich verschlechternde Patienten frühzeitig erkannt und vermeidbare Todesfälle verhindert werden. Dieser Beitrag stellt wesentliche Elemente eines modernen innerklinischen Notfallmanagements dar.

Introduction: The Emergency Medical Service Systems (EMS) in Germany are physician-based and provided by a two-tier system: One unit comprises physician staffing, and the second paramedics. Both units are simultaneously dispatched for a CPR call and are to arrive on scene at the same time. The physicians are allowed to terminate resuscitation efforts on scene or to indicate a transport to hospital under ongoing resuscitation.The aim of this study was to find out which patient survived after hospital admission with ongoing resuscitation. Materials and Methods: Data from the German Resuscitation Registry from the period 2014-2018, which have documented a hospital admission under ongoing resuscitation, will be examined. We excluded all patients without information on hospital outcome. Results: During the period, 7.146 patients were admitted to hospital under ongoing CPR. We included 2,884 patients with complete information on hospital outcome in this study. Of those, 73% were male and, on average, 62.2 years old. In 52% of all cases, mechanical chest compression devices were used. 12% of all patients admitted to hospital with ongoing resuscitation survived 24 hours and 4% can discharged alive, 2% with good neurological outcome (CPC ½). Patients survived to hospital discharge were younger (57.4 vs. 62.4 years), more male (79% vs. 73%) and have a shorter resuscitation free interval (3:49 vs. 4:53 min). If the patients can discharge alive, the initial rhythm were more often VF/pVT (71% vs. 30%) and more often the emergency physician presumed a cardiac cause of the arrest (79% vs. 67%). The rate of bystander resuscitation (39% vs. 36%) and telephone-guided CPR is similar between the two groups (18% vs. 16%). Conclusions: At all, 4% of all patients admitted to hospital under ongoing CPR can be discharged alive. The discharged patients are younger, more often male and have more often a cardiac cause of the arrest. More detailed analyses are necessary to define criteria for transport under ongoing resuscitation.

Aim An effective airway management is pivotal for treating hypoxia and to ensure reoxygenation during cardiopulmonary resuscitation (CPR). This matched-pair analysis from the German Resuscitation Registry (GRR) investigates the outcomes of various methods of airway management used on out-of-hospital cardiac arrest (OHCA) patients. Methods 89,220 OHCA patients were reported between 01/01/2007 and 12/31/2017. After applying exclusion and inclusion criteria, the resulting 19,196 patient's data were analyzed. Endpoints were return of spontaneous circulation (ROSC), hospital admission, 24-h survival, hospital discharge, and discharge with cerebral performance categories 1,2 (CPC1,2). Three categories of airway management were defined: endotracheal tube (“ETT”), laryngeal tube (“LT_only”), and laryngeal to endotracheal tube exchange (“LTEX”). The groups were matched with respect to age, gender, aetiology or location of OHCA, witnessing or CPR by lay people, initial rhythm, and use of epinephrine and amiodarone. Results “ETT” versus “LT_only” was associated with higher short- and long-term outcome rates and better neurological recovery (CPC_1.2: 7.7 vs. 5.8%, OR = 1.35, 95%-CI = 1.09–1.67, n = 5552). “LTEX” versus “LT_only” showed significantly higher ROSC- and 24-h survival rate (33.7 vs. 21.8%, OR = 1.82, 95%-CI = 1.51–2.2, n = 2302). “LTEX” versus “ETT” revealed significantly higher ROSC- and 24-h survival rate (34.6 vs. 30.4%, OR = 1.21, 95%-CI = 1.03–1.42, n = 2608). Conclusion “ETT” was associated with higher survival rates and better neurological outcomes in comparison to “LT_only”. The strategy of “LTEX” versus “LT_only” or “ETT” was only associated with better short-term outcomes. Our observational registry data suggests that endotracheal intubation by physician staffed EMS is the optimal airway strategy for OHCA in our system.

Witnesses of a sudden cardiac arrest play a key-role in resuscitation. Lay-persons should therefore be trained to recognize that a collapsed person who is not breathing at all or breathing normally might suffer from cardiac arrest. Information of professional emergency medical staff by lay-persons and their initiation of cardio-pulmonary-resuscitation-measures are of great importance for cardiac-arrest victims. Ambulance-dispatchers have to support lay-rescuers via telephone. This support includes the localisation of the nearest Automatic External Defibrillator (AED). Presentation of agonal breathing or convulsions due to brain-hypoxia need to be recognized as potential early signs of cardiac arrest. In any case of cardiac arrest chest-compressions need to be started. There is insufficiant data to recommend "chest-compression-only"-CPR as being equally sufficient as cardio-pulmonary-resuscitation including ventilation. Rescuers trained in ventilation should therefore combine compressions and ventilations at a 30:2-ratio. Movement of the chest is being used as a sign of sufficient ventilation. High-quality chest-compressions of at least 5 cm of depth, not exceeding 6 cm, are recommended at a ratio of 100-120 chest conpressions/min. Interruption of chest-compression should be avoided. At busy public places AED should be available to enable lay-rescuers to apply early defibrillation.

Introduction: Cardiac arrest is a common event and one of the leading causes of death. Especially within the elderly judgment on if the treatment will be in favor of the patient is a major challenge for the medical team. We evaluated the influence of the age on short and long-term survival after out-of- hospital cardiac arrest (OHCA). Hypothesis: Elderly people survive an out-of-hospital cardiac arrest with good neurological outcome. Methods: For this purpose, we analyzed data of 24,686 out-of-hospital cardiac arrest patients prospectively registered between 2008 and 2017 within the German Resuscitation Registry (GRR). The data records were divided according to different age groups and within the age group after shockable and non-shockable rhythms. The data sets were examined with regard to short and long-term survival. Short term survival was measured by expected and observed return-of-spontaneous circulation based on the RACA-score. The RACA-score is a previously published score to predict ROSC based on readily available variables after arrival of the emergency medical service (EMS) on scene. Long-term survival was differentiated in 24-hour survival, 30-day survival and hospital discharge with good neurological outcome (Cerebral Performance Category 1 and 2). Results: (Table 1) Conclusions: Our data shows that shockable rhythm and younger age are important factors of good neurological outcome after OHCA. Nevertheless, the few cases with shockable rhythms (411 out of 3227) in the elderly (>85 years) showed a favorable neurological outcome in 12.2% (77,2% of all patients with hospital discharge). In the non-shockable group 1.4% (58,3%) of the >85 year old had a good outcome. Data show that a resuscitation attempt in the elderly is not futile, especially if a shockable rhythm is detected. Further studies are necessary to maintain this decision.

Aim In terms of treatment options, the underlying cause of out-of-hospital cardiac arrest (OHCA) has an impact on survival. This study aimed to examine the frequencies of different causes of OHCA and their outcomes using data from a national resuscitation registry. Methods All pre-hospital cardiopulmonary resuscitations (CPR) documented in the German Resuscitation Registry between 2007 and 2017 were retrospectively investigated with regard to cause of cardiac arrest, return of spontaneous circulation (ROSC), and hospital discharge rate with good neurological outcome. To avoid selection bias, only rescue services with a return rate in the form ‘further clinical treatment’ of >30% were included, this resulted in a total return rate of 84% of the included data. Results In total, 33,772 patients were included. The most common causes of OHCA were cardiac events (62.2%), hypoxia (11.1%) and trauma (3.2%), in 17.2% no or unknown cause were documented. Overall, 44.8% of patients achieved ROSC, 13.1% of patients were discharged alive from hospital and 68.3% of these were in good neurological condition (9.0% of all patients). ROSC rates differed between 8.9% (sudden infant death syndrome) and 64.4% (intracranial bleeding), while discharge rates with good neurological outcome ranged between 0.9% (sepsis) and 14.0% (intoxication). Conclusion The most common causes of OHCA are cardiac events and hypoxia. Depending on the underlying cause, outcome after pre-hospital CPR varies widely with a survival rate with good neurological outcome ranging from 0.9 to 14%.

BACKGROUND Out of hospital cardiac arrest (OHCA) is one of the more common causes of death in Germany. Ambulance response time is an important planning parameter for emergency medical services (EMS) systems. We studied the effect of ambulance response time on survival after resuscitation from OHCA. METHODS We analyzed data from the German Resuscitation Registry for the years 2010-2016. First, we used a multivariate logistic regression analysis to determine the effect of ambulance response time (defined as the interval from the alarm to the arrival of the first rescue vehicle) on the hospital-discharge rate (in percent), depending on various factors, including resuscitation by bystanders. Second, we compared faster and slower EMS systems (defined as those arriving on the scene within 8 minutes in more than 75% of cases or in ≤ 75% of cases) with respect to the frequency of resuscitation and the number of surviving patients. RESULTS Our analysis of data from a total of 10 853 patients in the logistical regression model revealed that the rate of hospital discharge was significantly affected by the ambulance response time, bystander resuscitation, past medical history, age, witnessed vs. unwitnessed collapse, the initial heart rhythm, and the site of the collapse. The success of resuscitation was inversely related to the ambulance response time; thus, among patients who did not receive bystander resuscitation, the discharge rate declined from 12.9% at a mean response time of 1 minute and 10 seconds to 6.4% at a mean response time of 9 minutes and 47 seconds. Twelve faster EMS systems and 13 slower ones were identified, with a total of 9669 and 7865 resuscitated patients, respectively. The faster EMS systems initiated resuscitation more frequently and also had a higher discharge rate with good neurological outcome in proportion to the population of the catchment area (7.7 versus 5.6 persons per 100 000 population per year, odds ratio [OR] 0.72, 95% confidence interval [0.66; 0.79], p

Einfuhrung Der Erfolg auserklinischer Reanimationen beruht in erster Linie auf dem schnellen Beginn von Basismasnahmen durch Ersthelfer. Ein Konzept zur Erhohung des Ersthelferanteils ist die Anleitung des Anrufers durch einen Disponenten der Leitstelle, die sog. „Telefonreanimation“ (T-CPR). Die flachendeckende Einfuhrung der T-CPR ist eine der Kernforderungen der ILCOR-Leitlinien 2010. Ziel des in diesem Beitrag beschriebenen Verfahrens war es, durch Konsentierung von Qualitatsindikatoren die Grundlagen fur ein strukturiertes Qualitatsmanagement bei der T-CPR zu schaffen.

Airway management during resuscitation is pivotal for treating hypoxia and inducing reoxygenation. This German Resuscitation Registry (GRR) analysis investigated the influence of the type of airway used in patients treated with manual chest compression (mCC) and automated chest compression devices (ACCD) after out-of-hospital cardiac arrest (OHCA). Out of 42,977 patients (1 January 2010–30 June 2016) information on outcome, airway management and method of chest compressions were available for 27,544 patients. Hospital admission under cardiopulmonary resuscitation (CPR), hospital admission with return of spontaneous circulation (ROSC), hospital discharge and discharge with cerebral performance categories 1 and 2 (CPC 1,2) were used to compare outcome in patients treated with mCC vs. ACCD, and classified by endotracheal intubation (ETI), initial supraglottic airway device (SAD) changed into ETI, and only SAD use. Outcomes for hospital admission under ongoing CPR, hospital admission with ROSC, hospital discharge and neurologically intact survival (CPC 1,2) for mCC (84.8%) vs. ACCD (15.2%) groups were: 8.4/38.6%, 39.2/27.2%, 10.6/6.8%, 7.9/4.7% (p < 0.001), respectively. Only mCC with SAD/ETI for ever ROSC (OR 1.466, 95% CI: 1.353–1.588, p < 0.001) and mCC group with SAD/ETI for hospital admission with ROSC showed better outcomes (odds ratio [OR] 1.277, 95% confidence interval [CI]: 1.179–1.384, p < 0.001) in comparison to mCC treated with ETI. Compared to mCC/ETI, all other groups were associated with a decrease in neurologically intact survival. Better outcomes were found for mCC in comparison to ACCD and ETI showed better outcomes in comparison to SAD only. This observational registry study raised the hypothesis that SAD only should be avoided or SAD should be changed into ETI, independent of whether mCC or ACCD is used.

Sudden death due to cardiac arrest represents one of the greatest challenges facing modern medicine, not only because of the massive number of cases involved but also because of its tremendous social and economic impact. For many years, the magic figure of 1 per 1000 inhabitants per year was generally accepted as an estimate of the annual incidence of sudden death in the industrialized world, with a survival rate of 6 %. This estimate was based on large numbers of published reports of local, regional, national and multinational experience in the management of cardiac arrest. Measuring the global incidence of cardiac arrest is challenging as many different definitions of patient populations are used. Randomized controlled trials (RCT) provide insights into the value of specific treatments or treatment strategies in a well-defined section of a population. Registries do not compete with clinical studies, but represent a useful supplement to them. Surveys and registries provide insights into the ways in which scientific findings and guidelines are being implemented in clinical practice. However, as with clinical studies, comprehensive preparations are needed in order to establish a registry. This is all the more decisive because not all of the questions that may arise are known at the time when the registry is established. The German resuscitation registry started in May 2007 and currently more than 230 paramedic services and hospitals take part. More than 45,000 cases of out-of-hospital cardiac arrest and in-hospital cardiac arrest are included. With this background the German resuscitation registry is one of the largest databases in emergency medicine in Germany. After 5 years of running the preclinical care dataset was revised in 2012. Data variables that reflect current or new treatment were added to the registry. The postresuscitation basic care and telephone cardiopulmonary resuscitation (CPR) datasets were developed in 2012 and 2013 as well. The German resuscitation registry is an instrument of quality management and a research network. The registry documents the course in patients who have undergone resuscitation at the time points of first aid, further management and long-term outcome and it can therefore provide a complete presentation of the procedures carried out and the quality of the outcomes. In addition, important scientific questions can be answered from the database. For example, a score for benchmarking the outcome quality after out-of-hospital resuscitation, known as the return of spontaneous circulation (ROSC) after cardiac arrest (RACA) score, has been developed. The registry is available for all emergency medical services (EMS) and hospitals in Germany and other German-speaking countries.