[Micra™ leadless pacemaker : Clinical experience and perspectives]. / Sondenloser Schrittmacher Micra™ : Klinische Erfahrungen und Perspektiven.

Leadless pacemakers have the potential to fundamentally change the field of device therapy. As leads and generator pockets are no longer needed with this technology, many potentially dangerous complications of conventional pacemaker systems like lead fractures, lead endocarditis or pocket infections can be effectively avoided. At present, Micra™ (Medtronic Inc., Minneapolis, MN, USA) is the only commercially available leadless pacemaker. Since its first-in-human implantation in 2013, thousands of these devices have been implanted worldwide. This article presents an overview of the present clinical evidence and future perspectives of this promising new technology.

Myocardial infarction with proximal occlusion of the left anterior descending coronary artery in a 22-year-old patient with polycythaemia vera.

In this article, we report on a 22-year-old patient with myocardial infarction, which was the initial manifestation of polycythaemia vera. The awareness of myeloproliferative disorders as possible underlying disease - especially in young patients presenting with myocardial infarction - is crucial for clinical management, as a missed diagnosis can worsen the patient's further prognosis.

The effectiveness of ERC advanced life support (ALS) provider courses for the retention of ALS knowledge.

PURPOSE: Out-of-hospital emergency physicians in Austria need mandatory emergency physician training, followed by biennial refresher courses. Currently, both standardized ERC advanced life support (ALS) provider courses and conventional refresher courses are offered. This study aimed to compare the retention of ALS-knowledge of out-of-hospital emergency physicians depending on whether they had or had not participated in an ERC-ALS provider course since 2005. METHODS: Participants (n=807) from 19 refresher courses for out-of-hospital emergency physicians answered eight multiple-choice questions (MCQ) about ALS based on the 2005 ERC guidelines. The pass score was 75% correct answers. A multivariate logistic regression analyzed differences in passing scores between those who had previously participated in an ERC-ALS provider course and those who had not. Age, gender, regularity of working as an out-of-hospital emergency physician and the self-reported number of real resuscitation efforts within the last 6months were entered as control variables. RESULTS: Out-of-hospital emergency physicians who had previously attended an ERC-ALS provider course had a significantly higher chance of passing the MCQ test (OR=1.60, p=0.015). Younger age (OR=0.95, p<0.001), regular work as an out-of-hospital emergency physician (OR=2.66, p<0.001) and a higher number of self-reported resuscitations within the last 6months (OR=1.08, p=0.002) were also significant predictors of passing the test. CONCLUSION: Out-of-hospital emergency physicians that had attended an ERC-ALS provider course since 2005 had a higher retention of ALS knowledge compared to non-ERC-ALS course participants.

Does early administration of selenium improve neurological outcome after cardiac arrest?

OBJECTIVE: Existing data indicate that selenium supplementation may be beneficial in critically ill patients and in those with ischemic stroke. The purpose of this retrospective study was to explore the influence of early administration of selenium on neurological outcome after cardiopulmonary resuscitation (CPR). METHODS: We examined 227 consecutive unconscious patients after CPR and excluded 1 individual. The decision to administer selenium was left to the discretion of the attending physician, resulting in 124 patients (55%) who received intravenous selenium (200-1000 microg/d) for a median of 5 days after CPR. Patients were classified according to the best Glasgow-Pittsburgh cerebral performance categories (CPCs 1-5) achieved within 6 months of follow-up. RESULTS: The rate of regaining consciousness (CPC 1-3) after CPR was 58%. Multivariable logistic regression analysis confirmed a shockable first monitored rhythm (adjusted odds ratio, 3.73; 95% confidence interval, 1.85-7.52; P < .001), time to return of spontaneous circulation (adjusted odds ratio, 0.94; 95% confidence interval, 0.91-0.96; P < .001), administration of selenium (adjusted odds ratio, 2.38; 95% confidence interval, 1.19-4.76; P = .014), and the Simplified Acute Physiology Score II (adjusted odds ratio, 0.96; 95% confidence interval, 0.93-0.99; P = .034) as independent predictors of regaining consciousness after CPR. Survival at 6 months of follow-up was not improved significantly by selenium. CONCLUSION: This retrospective analysis leads to the hypothesis that early administration of selenium may improve neurological outcome after cardiac arrest.