[Vasopressin for therapy of persistent traumatic hemorrhagic shock: The VITRIS.at study]. / Vasopressin zur Therapie eines therapierefraktären traumatisch-hämorrhagischen Schocks: Die VITRIS.at-Studie.

While fluid management is established in controlled hemorrhagic shock, its use in uncontrolled hemorrhagic shock is being controversially discussed, because it may worsen bleeding. In the irreversible phase of hemorrhagic shock that was unresponsive to volume replacement, airway management and catecholamines, vasopressin was beneficial due to an increase in arterial blood pressure, shift of blood away from a subdiaphragmatic bleeding site towards the heart and brain and decrease of fluid resuscitation requirements. The purpose of this multicenter, randomized, controlled, international trial is to assess the effects of vasopressin (10 IU IV) vs. saline placebo IV (up to 3 injections at least 5 min apart) in patients with prehospital traumatic hemorrhagic shock that persists despite standard shock treatment. The study will be carried out by helicopter emergency medical service teams in Austria, Germany, Czech Republic, Portugal, the Netherlands and Switzerland. Inclusion criteria are adult trauma patients with presumed traumatic hemorrhagic shock (systolic arterial blood pressure <90 mmHg) that does not respond to the first 10 min of standard shock treatment (endotracheal intubation, fluid resuscitation and use of vasopressors) after arrival of the first emergency physician at the scene. The time window for randomization will close after 30 min of shock treatment. Exclusion criteria are terminal illness, no intravenous access, age <18 years, injury >60 min before randomization, cardiac arrest before randomization, presence of a do-not-resuscitate order, untreated tension pneumothorax, untreated cardiac tamponade, or known pregnancy. Primary study end-point is the hospital admission rate, secondary end-points are hemodynamic variables, fluid resuscitation requirements and hospital discharge rate.

[Successful resuscitation after rapid defibrillation by ski slope maintenance personnel. A case report]. / Erfolgreiche Reanimation nach Frühdefibrillation durch Pistendienst Ein Fallbericht.

Life-threatening incidents during leisure sport activities are not uncommon and also cardiovascular problems are occurring with ever-increasing frequency during alpine downhill skiing. Because these are emergency situations which regularly occur in distant or at least not easily accessible areas, assistance from lay persons can be the decisive factor for survival. The report describes a case of cardiopulmonary resuscitation of a skier in alpine terrain, who survived a cessation of circulation without sequelae after rapid defibrillation by maintenance personnel. A review of possibilities for improved emergency medical care in mountainous regions is also given.

[Public access defibrillation in alpine skiing areas: three case reports and a brief survey of the literature]. / Frühdefibrillation im Gletscherskigebiet: übertrieben oder Uberleben? 3 Fallberichte und eine Standortbestimmung.

In the months of winter 2002-2004, three cases of non-traumatic cardiac arrest occurred in the skiing area of the Stubaier Gletscher in Tyrol, Austria. All patients were initially resuscitated by ski patrol members, including the use of an automated external defibrillator (AED). Two of the patients were alive at hospital admission, one patient was discharged from hospital without neurological damage. The article describes the chain of survival in a high-alpine area, the installation of a modified public-access-defibrillation (PAD) system in a skiing area, and the prerequisites necessary for a successful PAD-program far away from an organized emergency medical system.

Effect of inhaled nitric oxide on intrapulmonary right-to-left-shunting in two rabbit models of saline lavage induced surfactant deficiency and meconium instillation.

Marked hypoxia secondary to intrapulmonary right-to-left shunting is a characteristic of respiratory failure in human neonates and can sometimes be complicated by additional extrapulmonary right-to-left shunting. To investigate the effect of inhaled nitric oxide (iNO) on intrapulmonary shunting, two typical pulmonary diseases of the newborn (respiratory distress syndrome and meconium aspiration) were reproduced in 32 mechanically ventilated rabbits weighing approximately 2 kg each. After tracheotomy, catheters were inserted into a jugular vein, a carotid artery and the right ventricle (to measure systolic right ventricular pressure [SRVP] and mixed venous oxygen content for calculation of shunt by Fick equation). Repeated airway lavages (LAV) with normal saline or repeated instillations of a suspension of human meconium (MEC) were continued until both the a/A-ratio was < or =0.14 and a peak inspiratory pressure > or =22 mbar was needed to keep the tidal volume constant at 10 ml/kg of body weight. Measurements of shunt, SRVP, systolic systemic pressure, physiological dead space, tidal volume and a ventilation index were performed before and after completion of lung damage and at 20 and 60 min after administering iNO at 80 ppm. Four groups of rabbits were studied (n=8 in each group): LAV control and intervention, Mec control and intervention. 60 min after starting iNO, there was a decrease in shunt (LAV: 67.6%+/-[SD] 11.3% vs 56.2+/-16.4, P=0.05; MEC: 52.6+/-6.3 vs 44.3+/-8.3, P < 0.05), in SRVP (LAV: 29.7 mmHg +/-10.1 mmHg vs 20.0+/-8.2, P < 0.01; MEC: 25.1+/-4.4 vs 22.3+/-5.0, P=0.46) and in dead space (% of tidal volume, LAV: 32.7%+/-10.5% vs 25.9+/-10.1, P < 0.01; MEC: 26.1+/-16.6 vs 18.9+/-10.1, P=0.05). These results demonstrate that iNO decreases intrapulmonary shunt (as well as SRVP and dead space). We suggest that iNO may be beneficial in human newborns with severe respiratory failure even if no extrapulmonary shunting via ductus or foramen ovale is apparent.

[ORL selection of French astronauts]. / La sélection O.R.L. des spationautes français.

Strict criteria were used, under the control of the Centre National d'Etudes Spatiales (CNES) to select seven French spationautes for future participation in human cargo space flights to take place between 1987-1991 within the framework of the scientific missions of the USA and USSR. Data and results of the clinical O.R.L. examinations and vestibular tests conducted during medical operations of this selection procedure are presented.