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Background:
The outcome of patients after OHCA has been poor. The probability of return of spontaneous circulation decreases over time. New therapeutic attempts like E-ECLS at the ED ...are tried to improve outcome of selected cases. The "Vienna Cardiac Arrest Registry" (VICAR) was introduced August 1, 2013 to collect Utstein-style data. Our aim was to identify those patients which might fulfill ‘load&go’ criteria for E-ECLS at the ED after OHCA.
Methods:
Therefore VICAR was retrospectively analysed for following criteria: age<75a;witnessed OHCA; basic life support (BLS); ventricular fibrillation/ventricular tachycardia (VF/VT); no return of spontaneous circulation (ROSC) within 15min CPR by EMS. Patients had to fulfill all these criteria.
Results:
Overall 701 patients were registered from August 1, 2013 to April 30, 2014. Excluded were because of poor documentation 26(4%) patients, because of missing criteria data 49(7%) and because they were younger than 18 years 7 (1%). The final analysis included 619(88%) patients; of those 68(11%) were transported under ongoing CPR to the ED. Moreover E-ECLS was applied in 15 patients at the ED.
Conclusion:
We found 30 (5%) patients to fulfill ’load & go’ criteria. Of 68 patients, who were transported with ongoing CPR to the ED only 8 (8%) met the criteria. Further promotion of these criteria within the ambulance crews is needed. Maybe these criteria could then serve as a decision support for emergency physicians/paramedics, which patients to transport under ongoing CPR to the ED for E-ECLS.
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Background:
Sudden cardiac arrest (SCA) and especially the out of hospital cardiac arrest (OHCA) is always an urgent situation, which requires well trained medical personnel. The ...emergency medical system (EMS) in Vienna took part in the Circulation Improving Care (CIRC) trial form 2008 to 2010. In this time they had an additional training. Therefore we revaluated the outcome of OHCA nowadays.
Method:
Interim report of a prospective observational study of all humans over eighteen, who suffer an OHCA resuscitated by the EMS in Vienna from August 2013 - April 2014. For those patients, who survived 30 days, a cerebral performance category score (CPC) was evaluated.
Results:
During nine months 701 patients could be investigated and 625 achieved the protocol for this trial. The median age of the patients was 68 years (IQR 59-79) and 399 (64%) were male. Witnessed by bystanders was the cardiac arrest in 359 (57%) patients. In the latter patients restoration of spontaneous circulation (n=223, 36%)(ROSC) and 30 day survival (n=166, 27%) was significantly more often achieved than in patients with non-witnessed cardiac arrest. Bystanders provided chest compressions in 284 (45%) cases and in this subgroup a shockable initial rhythm was more often (p<0.0001). Still in 189 (53%) of the patients where the cardiac arrest was witnessed, bystander resuscitation wasn′t attempted. An initial shockable rhythm was found in 146 (24%) patients with significant better outcome in all primary outcome measures. Of the 62 (10%) 30-days-survivors, 33 (6%) had good neurological outcome with a CPC 1-2.In 12 (2%) cases the CPC was missing.
Conclusion:
The results are comparable to findings of our previous studies. A significant better result in all primary outcome measures could be found for witnessed OHCA with an initial shockable rhythm. Furthermore those patients with bystander CPR had significant more often a shockable initial rhythm. Therefore more efforts have to be invested into encouraging the community to start with a bystander CPR if an OHCA is witnessed.
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INTRODUCTION:
With an incidence of ~45patients with out-of hospital cardiac arrest (OHCA) /100.000 inhabitants per year and thus over 700 cases annually, but a survival rate as low as ...10%, OHCA remains still a challenge the chain of survival. Recently ventilation has gained less importance for BLS and thus the question arises, if this attitude was mirrored during ALS measures provided by ambulance crews. Therefore our analysis assessed the quality of ventilation during out of hospital cardiac arrests.
METHODS:
Over a period of 9 months, from August 1st 2013 until April 30th 2014, all patients suffering from an OHCA, aged 18 years and above and treated by the emergency medical service crews in Vienna, Austria were included in this study. A collective of 701 consecutive cases have been analyzed using the ECG- and impedance data recorded by the defibrillators used. On the basis of this data, the abidance of the quality standards of ventilation was examined using the current guidelines of the European Resuscitation Council of 2010 as gold standard. After the evaluation of each case, the responding EMS-teams were informed about the quality of the resuscitation via a feedback form.
RESULTS:
Endotracheal intubation was accomplished in 338 patients (47%). Ventilation was performed in accordance to the ERC guidelines in 49% (CI: 46-52) of total recorded ventilation minutes. Patients who had restoration of spontaneous circulation (ROSC) (n=135) after being intubated were ventilated with 9 (CI: 9-11; variance: 11) ventilations per minute. In patients not achieving ROSC (n=203) 10 (CI: 9-11; variance: 25) ventilations per minute were administered. Patients that were ventilated with a supraglottic airway device or a bag valve and mask received 6(SD±4) ventilations per minute.
CONCLUSION:
The high ventilation rate standard deviations within the compliance to guidelines suggest that there are numerous cases in which ventilation standards are not met. Therefore further analysis will be necessary to find out, what influence this might have on outcome and if it will be necessary to put more emphasis in upcoming discussions on the quality of ventilation at least during advanced life support.
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Background:
Sudden cardiac arrest (SCA) is one of the most common causes of death in western, industrialized countries. The hospital discharge rate after Out-of-Hospital Cardiac Arrests ...(OHCA with cardiac etiology and first monitored rhythm shockable) was 2011 24.7% in Vienna (Austria). The overall bystander CPR rate was 42% and in only 4% of the cases an AED was used by laypeople. Therefore, we wanted to assess whether a police first responder program with immediately initiated resuscitation measures (chest compression and use of an AED within the first three minutes) may increase survival rates after SCA in the Austrian capital.
Methods:
The police forces in Vienna were provided with 112 AEDs (52 in police cars / 60 at police stations) and CPR plus AED training. Emergency dispatching was organized such as AED-equipped police (P-AED) and conventional emergency medical service (EMS) responders were simultaneously dispatched to patients with assumed cardiac arrest. One month survival states of cardiac arrest victims provided with P-AED were compared to patient outcomes when EMS was the sole responder.
Results:
From August 2013 to April 2014, a 50% hospital discharge rate was observed for victims with initial ventricular fibrillation (VF) in the P-AED group, compared to 26% for standard EMS treatment. However, the overall survival benefit was diluted by the fact - that 75% of the initial rhythms were non-shockable, reducing the absolute survival to 10%. There have been 701 OHCA in this time, but due to lack of information, only 654 were included in the study. Figure 1 shows the outcome in detail.
Conclusion:
Use of AEDs by police first responders significantly increases survival and hospital discharge in VF patients. There was no benefit for victims with non-shockable rhythms yet. Further campaigning will be necessary, to increase the number of police first responder commitments and to implement an Austria wide P-AED system.
The efficacy of triple-drug combination regimens such as epirubicin, oxaliplatin and capecitabine (EOX) is superior to standard cisplatin/5-fluorouracil, but considerable toxicity needs to be taken ...into account in patients with upper gastrointestinal adenocarcinoma. Therefore, we aimed to establish a modified version of the EOX regimen with improved tolerability for these patients.
Patients received palliative first-line chemotherapy with a modified EOX regimen repeated every three weeks (epirubicin 50 mg/m(2) i.v., day 1; oxaliplatin 130 mg/m(2) i.v., day 1; capecitabine at a twice-daily dose of 1000 mg/m(2) p.o. for two weeks).
Out of 51 patients, partial remission was observed in five (10.2%) and stable disease in 31 (60.8%). Progression-free survival was four months, and overall survival twelve months.
Modified EOX was generally well-tolerated and, therefore, further investigation within prospective clinical trials is warranted.
A retrospective analysis was carried out to evaluate toxicity and efficacy of the combination chemotherapy of docetaxel, cisplatin and 5-fluorouracil (DCF) plus granulocyte colony-stimulating factor ...prophylaxis (G-CSF) in patients with metastatic gastric and gastroesophageal junction adenocarcinoma.
Eighteen patients received intravenous 75 mg/m2 docetaxel, 75 mg/m2 cisplatin, both given on day 1 and 750 mg/m2 5-fluorouracil, on days 1 to 5 plus G-CSF on day 6, all repeated every 3 weeks.
Response rate was 28%, time to progression and overall survival were 26 and 54 weeks, respectively. The most common hematological WHO toxicities were anemia and leukocytopenia, which occurred in 18/18 and in 12/18 patients. WHO Grade 4 neutropenia occurred in one patient whereas nonhematological toxicity was generally mild.
We conclude that DCF combination plus G-CSF prophylaxis is a safe and active regimen for patients with metastatic gastric and gastroesophageal junction adenocarcinoma.
