[The DGAI CPR registry - the datasets "hospital care" and "long-term process"]. / Das DGAI-Reanimationsregister - Die Datensätze "Weiterversorgung" und "Langzeitverlauf"

After several years of preparation the German Society of Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin--DGAI) has, during its annual conference 2007, officially launched the DGAI CPR registry. After implementation of the dataset "primary care" in 2004, the datasets "definite care" and "long-term process" have now been released. The completed, internet based database is open for any interested person or institution as a tool for quality management. Data may be recorded online, and basic analyses be performed immediately. Beyond that benchmarks with other institutions are possible, by including the well accepted Utstein style on international level too.

Accuracy and precision of three different methods to determine Pco2 (Paco2 vs. Petco2 vs. Ptcco2) during interhospital ground transport of critically ill and ventilated adults.

BACKGROUND: Interhospital transportation of critically ill and mechanically ventilated patients represents a common, yet difficult problem. Three different methods to determine Pco2 during transport are available: arterial blood gas analysis (Paco2), end-tidal (Petco2) and transcutaneous (Ptcco2) measurement. The aim of the present study is to analyze accuracy and precision of those different methods simultaneously in critically ill and ventilated adults during interhospital transport. METHODS: Patients scheduled for interhospital transport were investigated after approval of the local ethics committee in the prospective study. Pco2 was determined five times in each patient during the transport simultaneously by (1) arterial blood gas analysis (Paco2[Immediate Response Mobile Analyzer, IRMA]), (2) end-tidal (Petco2), and (3) transcutaneous (Ptcco2) measurements. The results were compared with an in-hospital reference measurement performed by an ABL 625 blood gas analyzer (Paco2[ABL625]). For statistical analysis the Bland-Altman method was used. A p < 0.05 was considered statistically significant. RESULTS: One hundred seventy data sets (Paco2[IRMA], Paco2[ABL625], Petco2, Ptcco2) were obtained in 34 patients (61 years +/- 16 years old; 19 male patients, 15 female patients). The mean Paco2(ABL625) was 43.2 mm Hg +/- 8.8 mm Hg ranging from 24.9 mm Hg to 72.4 mm Hg. Bland-Altman analysis revealed a bias and precision of -0.6 mm Hg +/- 2.5 mm Hg for the arterial blood gas analysis with the mobile IRMA device and -0.6 mm Hg +/- 7.5 mm Hg for the transcutaneous measurement (p > 0.05). Bias and precision (-5.3 mm Hg +/- 6.1 mm Hg) of endexpiratory CO2-measurement differed significantly (p < 0.003) when compared with the reference. CONCLUSIONS: During interhospital transport Paco2(IRMA) and Ptcco2 provide the best accuracy when compared with the reference measurement. Patients who either require a tight control of Pco2 or endured lengthy transportation could benefit greatly from the combination of expiratory capnography with mobile arterial blood gas analysis or the transcutaneous measurement of Pco2.

Intestinal ischaemia during cardiac arrest and resuscitation: comparative analysis of extracellular metabolites by microdialysis.

Intestinal ischaemia is a major complication of shock syndromes causing translocation of bacteria and endotoxins and multiple organ failure in intensive care patients. The present study was designed to use microdialysis as a tool to monitor intestinal ischaemia after cardiac arrest and resuscitation in pigs. For this purpose, microdialysis probes were implanted in pig jejunal wall, peritoneum, skeletal muscle and brain, and interstitial fluid was obtained during circulatory arrest (induced by ventricular fibrillation) and after return of spontaneous circulation (ROSC). Cardiac arrest for 4 min caused a prolonged (60 min) reduction of blood flow in jejunal wall, muscle and brain as determined by the ethanol technique. This was accompanied by cellular damage in heart muscle and brain as indicated by increased levels of troponin-I and protein S-100, respectively. Plasma levels of glucose, lactate and choline were increased at 15-60 min following cardiac arrest. In contrast, cardiac arrest induced a rapid but variable decrease of interstitial glucose levels in all monitored organs; this decrease was followed by an increase over baseline during reperfusion. In the intestine, lactate, glutamate and choline levels were increased during ischaemia and reperfusion for 60-120 min; intestinal and peritoneal samples yielded parallel changes of lactate levels. Brain and muscle samples showed similar changes as in intestinum and peritoneum except for glutamate, which was increased in brain but not in muscle. We conclude that intestinal ischaemia occurs as a consequence of cardiac arrest and resuscitation and can be monitored by in vivo microdialysis. Comparative analysis by multi-site microdialysis reveals that the intestine is equally or even more sensitive to ischaemia than brain or muscle.

Hypertonic-hyperoncotic solutions reduce the release of cardiac troponin I and s-100 after successful cardiopulmonary resuscitation in pigs.

UNLABELLED: In some patients, cardiopulmonary resuscitation (CPR) can revive spontaneous circulation (ROSC). However, neurological outcome often remains poor. Hypertonic-hyperoncotic solutions (HHS) have been shown to improve microvascular conductivity after regional and global ischemia. We investigated the effect of infusion of HHS in a porcine CPR model. Cardiac arrest was induced by ventricular fibrillation. Advanced cardiac life support was begun after 4 min of nonintervention and 1 min of basic life support. Upon ROSC, the animals randomly received 125 mL of either normal saline (placebo, n = 8) or 7.2% NaCl and 10% hydroxyethyl starch 200,000/0.5 (HHS, n = 7). Myocardial and cerebral damage were assessed by serum concentrations of cardiac troponin I and astroglial protein S-100, respectively, up to 240 min after ROSC. In all animals, the levels of cardiac troponin I and S-100 increased after ROSC (P < 0.01). This increase was significantly blunted in animals that received HHS instead of placebo. The use of HHS in the setting of CPR may provide a new option in reducing cell damage in postischemic myocardial and cerebral tissues. IMPLICATIONS: Infusion of hypertonic-hyperoncotic solutions (HHS) after successful cardiopulmonary resuscitation in pigs significantly reduced the release of cardiac troponin I and cerebral protein S-100, which are sensitive and specific markers of cell damage. Treatment with HHS may provide a new option to improve the outcome of cardiopulmonary resuscitation.