Resuscitation academy Germany – systemic improvements for better out-of-hospital cardiac arrest outcomes

BackgroundThe first Resuscitation Academy Germany (RAD) aims to improve the outcomes after out-of-hospital cardiac arrest (OHCA) systemically and sustainably according to Eisenberg’s 10-step program developed 2008 in Seattle/King County, USA.1 Participating Emergency Medical Services (EMS) have reported significant improvements in their systems and patient outcomes.2The European Resuscitation Council Guidelines 2021 recommend the implementation.3MethodThe RAD was launched in January 2020. It involves six EMS regions (Berlin, Dortmund, Kiel, Plön, Vorpommern-Greifswald, Rostock) and runs for 30 months following a structured process with continuous monitoring and ongoing sequential meetings. A key focus is on implementation of local projects. The goal is the systemic and continuous improvement measured by the German Resuscitation Registry (GRR) and the ‘RAD-Online-Tool’. The ‘RAD-Online-Tool’ is a system-self-assessment tool (SSAT) used at different points over the study period.ResultsThe six EMS regions have conducted the SSAT to identify potentials for improvement and translate them into multiple projects and goals. All participants are aiming for better data quality or improved usage of the GRR and to introduce a High-Performance-CPR-Program. Some EMS dispatch centers started to measure and improve their Telephone-CPR and/or Rapid Dispatch. Several systems will implement lay rescuer integration via app or improve AED integration. Other projects are on multiprofessional training for paramedics and emergency physicians or a Paramedic-Supervisor-Pilot program.ConclusionInitial data and reports from participating EMS regions show success and potential for further improvement. For Germany, the format of consecutive workshops and continuous support seems particularly appropriate.ReferencesThe Resuscitation Academy Foundation. 10 STEPS for Improving Survival from Cardiac Arrest. 2nd ed. Seattle;2019 [cited 2021 Nov 10]. Available from: https://www.resuscitationacademy.org/s/10_steps_2019-h2yk.pdf.Global Resuscitation Alliance. Steady increase in survival: 50% improvement is possible;2019 [cited 2021 Nov 10]. Available from: https://www.globalresuscitationalliance.org/wp-content/uploads/2019/12/GRA_Data_Collection.pdf.Semeraro F, Greif R, Böttiger BW, Burkart R, Cimpoesu D, Georgiou M, et al. European Resuscitation Council Guidelines 2021: Systems saving lives. Resuscitation 2021;161:80–97. doi: 10.1016/j.resuscitation.2021.02.008. PubMed PMID: 33773834.Conflict of interestSSe, JTG is member of the steering committee of the German Resuscitation Registry. The authors declare that they have no competing interests.FundingThe German Resuscitation Academy received fundings by the State of Schleswig-Holstein (fund for the further development of (multi-sector) patient care) and the Damp Foundation.

A snapshot of European neurosurgery December 2019 vs. March 2020: just before and during the Covid-19 pandemic.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or Covid-19), which began as an epidemic in China and spread globally as a pandemic, has necessitated resource management to meet emergency needs of Covid-19 patients and other emergent cases. We have conducted a survey to analyze caseload and measures to adapt indications for a perception of crisis. METHODS: We constructed a questionnaire to survey a snapshot of neurosurgical activity, resources, and indications during 1 week with usual activity in December 2019 and 1 week during SARS-CoV-2 pandemic in March 2020. The questionnaire was sent to 34 neurosurgical departments in Europe; 25 departments returned responses within 5 days. RESULTS: We found unexpectedly large differences in resources and indications already before the pandemic. Differences were also large in how much practice and resources changed during the pandemic. Neurosurgical beds and neuro-intensive care beds were significantly decreased from December 2019 to March 2020. The utilization of resources decreased via less demand for care of brain injuries and subarachnoid hemorrhage, postponing surgery and changed surgical indications as a method of rationing resources. Twenty departments (80%) reduced activity extensively, and the same proportion stated that they were no longer able to provide care according to legitimate medical needs. CONCLUSION: Neurosurgical centers responded swiftly and effectively to a sudden decrease of neurosurgical capacity due to relocation of resources to pandemic care. The pandemic led to rationing of neurosurgical care in 80% of responding centers. We saw a relation between resources before the pandemic and ability to uphold neurosurgical services. The observation of extensive differences of available beds provided an opportunity to show how resources that had been restricted already under normal conditions translated to rationing of care that may not be acceptable to the public of seemingly affluent European countries.