Quality management in resuscitation--towards a European cardiac arrest registry (EuReCa).

BACKGROUND: Knowledge about the epidemiology of cardiac arrest in Europe is inadequate. AIM: To describe the first attempt to build up a Common European Registry of out-of-hospital cardiac arrest, called EuReCa. METHODS: After approaching key persons in participating countries of the European Resuscitation Council, five countries or areas within countries (Belgium, Germany, Andalusia, North Holland, Sweden) agreed to participate. A standardized questionnaire including 28 items, that identified various aspects of resuscitation, was developed to explore the nature of the regional/national registries. This comprises inclusion criteria, data sources, and core data, as well as technical details of the structure of the databases. RESULTS: The participating registers represent a population of 35 million inhabitants in Europe. During 2008, 12,446 cardiac arrests were recorded. The structure as well as the level of complexity varied markedly between the 5 regional/national registries. The incidence of attempted resuscitation ranged between registers from 17 to 53 per 100,000 inhabitants each year whilst the number of patients admitted to hospital alive ranged from 5 to 18 per 100,000 inhabitants each year. Bystander CPR varied 3-fold from 20% to 60%. CONCLUSION: Five countries agreed to participate in an attempt to build up a common European Registry for out-of-hospital cardiac arrest. These regional/national registries show a marked difference in terms of structure and complexity. A marked variation was found between countries in the number of reported resuscitation attempts, the number of patients brought to hospital alive, and the proportion that received bystander CPR. At present, we are unable to explain the reason for the variability but our first findings could be a 'wake-up-call' for building up a high quality registry that could provide answers to this and other key questions in relation to the management of out-of-hospital cardiac arrest.

Fotemustine in patients with relapsing malignant gliomas - a phase-ii trial.

Eleven patients with relapsing malignant glioma were treated with fotemustine chemotherapy, a new nitrosourea derivative. One partial response of 13 months duration occurred, resulting in a marked improvement of the quality of life of the patient. Seven patients had stable disease for a median duration of 5 months. Median survival from inclusion in the study was 6 months. Toxicity was mainly hematologic and manageable. We confirm that fotemustine has some activity in patients with relapsing malignant glioma.

Dose-finding study of tropisetron in cisplatin-induced nausea and vomiting.

BACKGROUND: The purpose of these two studies was to define the optimal therapeutic dose of the 5-HT3 receptor antagonist tropisetron (Navoban, ICS 205-930) in cisplatin-induced nausea and vomiting. PATIENTS AND METHODS: In two multicentre, dose-finding studies of tropisetron in the prevention of cisplatin-induced emesis, cancer patients naïve to chemotherapy or who had not vomited previously were randomly assigned to tropisetron 5, 10, 20 or 40 mg (study I, 143 patients) or 2 or 5 mg (study II, 74 patients), administered as a single intravenous dose over 15 minutes just before the start of chemotherapy. RESULTS: In study I total control of acute symptoms (no nausea and no vomiting) was achieved in, respectively, 66%, 50%, 64% and 50% in the 5-, 10-, 20- and 40-mg groups of patients. A total absence of vomiting alone was seen in, respectively, 71%, 51%, 61% or 58% of patients. None of the differences were statistically significant. In study II there was total acute control in 57% of patients in the 2-mg group and 63% in the 5-mg group (p = NS). Total or major control of vomiting (< or = 2 emetic episodes) was the primary endpoint in study II and was seen in 68% of patients for the 2-mg and 86% for the 5-mg group (p = 0.055). In this study failures ( > 3 vomiting) were rescued with a second infusion of tropisetron (5-mg fixed dose). Three of 8 rescue infusions administered in the 2-mg group prevented further vomiting whereas none of 5 were successful in the 5-mg group during course 1 of chemotherapy. The most frequently reported adverse effects (over all three courses) were headache (6.0% of 217 patients) hypertension (3.7%) and diarrhoea (2.8%). None of the 25 deaths which occurred during the two studies were attributable to tropisetron. CONCLUSIONS: Thus, a single dose of tropisetron provides 24-hour protection against cisplatin-induced nausea and vomiting and is well tolerated. These studies do not allow a firm conclusion but suggest that 2 mg may be subtherapeutic and that 5 mg is as effective as higher doses.

Doppler evaluation of left ventricular filling: effect of verapamil on non-obstructive hypertrophic cardiomyopathy.

Impaired left ventricular (LV) filling is known to be a major determinant of non-obstructive hypertrophic cardiomyopathy (HCM). Seventeen patients with non-obstructive HCM (mean age 71 years) were investigated by Doppler echocardiography, before and after oral treatment with verapamil (mean daily doses: 335 mg). Diagnosis was based on clinical and echocardiographic data. Mitral regurgitation was absent or mild. Heart rate, PQ interval and mitral regurgitation did not change after treatment. All calculated values of Doppler LV filling improved significantly: corrected relaxation time, ratio of atrial to early velocity, EF slope and pressure half-time (P less than 0.005) showed more significant differences than more sophisticated indices using time-velocity integrals of Doppler LV filling flow (P less than 0.005). Results appear to reflect an effect of verapamil on LV relaxation; a slight effect of a modified load was nevertheless not excluded. We conclude that all parameters of Doppler LV filling show marked improvement in this elderly group with non-obstructive HCM, after oral verapamil. Doppler echocardiography is an easy and useful clinical method to assess the effect of a drug on ventricular relaxation of non-obstructive HCM.