[Postcardiac arrest treatment guide]. / Praxisleitfaden für die Postreanimationsbehandlung.

BACKGROUND: Treatment after cardiac arrest has become more complex and interdisciplinary over the last few years. Thus, the clinically active intensive and emergency care physician not only has to carry out the immediate care and acute diagnostics, but also has to prognosticate the neurological outcome. AIM: The different, most important steps are presented by leading experts in the area, taking into account the interdisciplinarity and the currently valid guidelines. MATERIALS AND METHODS: Attention was paid to a concise, practice-oriented presentation. RESULTS AND DISCUSSION: The practical guide contains all important steps from the acute care to the neurological prognosis generation that are relevant for the clinically active intensive care physician.

Bedside tests for predicting difficult airways: an abridged Cochrane diagnostic test accuracy systematic review.

Although bedside screening tests are routinely used to identify people at high risk of having a difficult airway, their clinical utility is unclear. We estimated the diagnostic accuracy of commonly used bedside examination tests for assessing the airway in adult patients without apparent anatomical abnormalities scheduled to undergo general anaesthesia. We searched for studies that reported our pre-specified bedside index screening tests against a reference standard, published in any language, from date of inception to 16 December 2016, in seven bibliographic databases. We included 133 studies (127 cohort type and 6 case-control) involving 844,206 participants. Overall, their methodological quality (according to QUADAS-2, a standard tool for assessing quality of diagnostic accuracy studies) was moderate to high. Our pre-specified tests were: the Mallampati test (6 studies); modified Mallampati test (105 studies); Wilson risk score (6 studies); thyromental distance (52 studies); sternomental distance (18 studies); mouth opening test (34 studies); and the upper lip bite test (30 studies). Difficult facemask ventilation, difficult laryngoscopy, difficult intubation and failed intubation were the reference standards in seven, 92, 50 and two studies, respectively. Across all reference standards, we found all index tests had relatively low sensitivities, with high variability, but specificities were consistently and markedly higher than sensitivities. For difficult laryngoscopy, the sensitivity and specificity (95%CI) of the upper lip bite test were 0.67 (0.45-0.83) and 0.92 (0.86-0.95), respectively; upper lip bite test sensitivity (95%CI) was significantly higher than that for the mouth opening test (0.22, 0.13-0.33; p < 0.001). For difficult tracheal intubation, the modified Mallampati test had a significantly higher sensitivity (95%CI) at 0.51 (0.40-0.61) compared with mouth opening (0.27, 0.16-0.41; p < 0.001) and thyromental distance (0.24, 0.12-0.43; p < 0.001). Although the upper lip bite test showed the most favourable diagnostic test accuracy properties, none of the common bedside screening tests is well suited for detecting unanticipated difficult airways, as many of them are missed.

Reduced hands-off-time and time to first shock in CPR according to the ERC Guidelines 2005.

BACKGROUND AND AIM: Chest compressions and early defibrillation are crucial in cardiopulmonary resuscitation (CPR). The Guidelines 2005 brought major changes to the basic life support and automated external defibrillator (BLS-AED) algorithm. We compared the European Resuscitation Council's Guidelines 2000 (group '00) and 2005 (group '05) on hands-off-time (HOT) and time to first shock (TTFS) in an experimental model. METHODS: In a randomised, cross-over design, volunteers were assessed in performing BLS-AED over a period of 5min on a manikin in a simulated ventricular fibrillation cardiac arrest situation. Ten minutes of standardised teaching and 10min of training including corrective feedback were allocated for each of the guidelines before evaluation. HOT was chosen as the primary and TTFS as the secondary outcome parameter. RESULTS: Forty participants were enrolled; one participant dropped out after group allocation. During the 5-min evaluation period of adult BLS-AED, HOT was significantly (p<0.001) longer in group '00 [273+/-3s (mean+/-standard error)] than in group '05 (188+/-3s). The TTFS was significantly (p<0.001) longer in group '00 (91+/-3s) than in group '05 (71+/-3s). CONCLUSION: In this manikin setting, HOT and TTFS improved with BLS-AED performed according to Guidelines 2005.

Bed rest for acute uncomplicated myocardial infarction.

BACKGROUND: Bed rest is prescribed to all patients with acute myocardial infarction (AMI), but to a variable extent. Current guidelines (American College of Cardiology/ American Heart Association) recommend at least 12 hours bed rest in patients with uncomplicated ST-elevation myocardial infarction, however the basis for this recommendation is unclear. OBJECTIVES: To compare the effects of short versus longer bed rest in patients with uncomplicated AMI. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2005), MEDLINE (January 1966 - August 2005), EMBASE (January 1988 - August 2005), PASCAL BioMed (January 1996 - August 2005); PsycINFO (January 1966 - August 2005) and BIOSIS Previews (January 1990 - August 2005). SELECTION CRITERIA: Randomised and quasi-randomised controlled trials of short versus longer bed rest in patients with uncomplicated AMI were sought. DATA COLLECTION AND ANALYSIS: Study selection was performed independently by at least two investigators according to the predefined inclusion criteria. Data were extracted by two investigators independently and in duplicate. Authors were contacted to obtain missing information. MAIN RESULTS: We found 15 trials with 1487 patients assigned to a short period of bed rest (median 6 days) and 1471 patients assigned to longer bed rest (median 13 days). Generally the studies were outdated and appeared to be of moderate to poor methodological reporting quality. There was no evidence that shorter bed rest was more harmful than longer bed rest in terms of all cause mortality (RR=0.85 (95%CI 0.68 to 1.07), cardiac mortality (RR=0.81 (95%CI 0.54 to 1.19), or reinfarction (RR=1.07 (95%CI 0.79 to 1.44)). AUTHORS' CONCLUSIONS: Bed rest ranging from 2 to 12 days appears to be as safe as longer periods of bed rest. The quality of most trials is unsatisfactory. Current bed rest recommendations are not supported by the existing evidence as the optimal duration of bed rest is unknown. The lack of adequate trials is surprising, considering the large size of several studies to compare effectiveness of drugs on people with AMI.

Practical impact of the European Resuscitation Council's BLS algorithm 2005.

BACKGROUND: The European Resuscitation Council (ERC) guidelines 2005 have brought major changes in the BLS algorithm. The aim of our investigation was to look for the practical impact of these modifications. METHODS: In a randomized cross-over design we evaluated how adults would adhere to the BLS algorithm of the ERC guidelines 2000 (group A) compared to the guidelines 2005 (group B). The secondary endpoint was to determine the amount of time that elapsed before the start of the chest compressions in the two different groups. Participants were recruited from the streets and an office building of the Austrian Red Cross and were randomized to commence either with A or B. The volunteers were taught the allocated BLS sequence according to their group placement, and before evaluation each of the two groups was given the opportunity to train until they felt confident in using the algorithm. Performance during evaluation was documented automatically with a recording resuscitation manikin (Resusci-Anne, Skill Reporter). RESULTS: Sixty people were included in the study, one individual dropped out after randomisation. In group A 9/59 (15.25%) participants followed the algorithm correctly versus 24/59 (40.68%) in group B (p=0.006). The time to start of chest compressions was significantly shorter in group B (21.31+/-7.11s), compared to group A (36.68+/-11.75s, p<0.01). CONCLUSION: Compared to the 2000 BLS algorithm, the 2005 BLS sequence seems to be easier to learn and to retain, though nearly 60% of participants did not follow the new algorithm correctly. As expected, there was a significantly shorter time elapsing before the start of chest compressions when applying the 2005 algorithm. These findings should translate to better survival after cardiac arrest.