ABSTRACT
Perfect, uninterrupted basic life support (BLS) is the key for successful cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA). Time plays an important role in the treatment of OHCA. This applies both to the time until the start of BLS and the reduction of all pauses during resuscitation, especially chest compressions. In 2022, the rate of bystander-CPR showed an absolute increase of 4% compared to previous years. The bystander-CPR rate is currently above 50%. Compared to OHCA in adults, cardiac arrest in children is rare in Germany. In the period from 2007 to 2021, the incidence was 3.08 per 100000 children. In addition, the etiology in children varies depending on the age group. While hypoxia is often the cause of circulatory arrest in younger children, trauma and drowning accidents are the main causes in school-age children. Different additional diagnostic and therapeutic strategies have been evaluated over the last years. Point-of-care ultrasound during resuscitation should only be performed by experienced users. Interrupting chest compressions and thus prolonging the no-flow phases must be avoided. Double sequential external defibrillation after the third shock can successfully terminate refractory ventricular fibrillation. While further studies are needed, emergency medical systems should train their teams to avoid complications. In refractory OHCA, extracorporeal CPR should be considered. In the case of in-hospital cannulation, immediate transport should be weighed against impaired chest compression quality. Therefore, transportation under CPR is only beneficial if there is an indication for further treatment.
Subject(s)
Cardiopulmonary Resuscitation , Out-of-Hospital Cardiac Arrest , Humans , Out-of-Hospital Cardiac Arrest/therapy , Germany , Emergency Medical Services , ChildABSTRACT
BACKGROUND: The need for a concept for the nationwide strategic transfer of critical care patients in Germany was highlighted during the COVID-19 (coronavirus disease 2019) pandemic. Despite the cloverleaf concept developed specifically for this purpose, the transfer of large numbers of critical care patients represents a major challenge. With the help of a computer simulation, the SCATTER research project uses a fictitious example to test, develop, and recommend transfer strategies. METHOD: The simulation was programmed after collecting procedural and structural data on critical care transports within Germany. The simulation allows altering various parameters and testing different transfer scenarios. In a fictitious scenario, nationwide transfers starting from Schleswig-Holstein were simulated and evaluated using predetermined criteria. RESULTS: In the case of ground-based transfers, it became apparent that, depending on the selected target region, not all patients could be transferred due to the limited range of ground-based vehicles. Although a higher number of patients can be transferred by air, this is associated with additional gurney changes and potential risk to the patient. A distance-dependent transport strategy led to the identical results as purely air-bound transport, since air-bound transport was always chosen due to the long distances. DISCUSSION: The simulation can be used to develop recommendations and to draw important conclusions from different transfer strategies.
