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Voß F, Thevathasan T, Scholz KH, Böttiger BW, Scheiber D, Kabiri P, Bernhard M, Kienbaum P, Jung C, Westenfeld R, Skurk C, Adler C, Kelm M. Accredited cardiac arrest centers facilitate eCPR and improve neurological outcome. Resuscitation 2024; 194:110069. [PMID: 38061578 DOI: 10.1016/j.resuscitation.2023.110069] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) remains a frequent medical emergency with low survival rates even after a return of spontaneous circulation (ROSC). Growing evidence supports formation of dedicated teams in scenarios like cardiogenic shock to improve prognosis. Thus, the European Resuscitation Council (ERC) recommended introduction of Cardiac Arrest Centers (CAC) in their 2015 guidelines. Here, we aimed to elucidate the effects of newly introduced CACs in Germany regarding survival rate and neurological outcome. METHODS A multicenter retrospective observational cohort study was performed at three university hospitals and outcomes after OHCA were compared before and after CAC accreditation. Primary outcomes were survival until discharge and favorable neurological status (CPC 1 or 2) at discharge. RESULTS In total 784 patients (368 before and 416 after CAC accreditation) were analyzed. Rates of immediate percutaneous coronary intervention (40 vs. 52%, p = 0.01) and implementation of extracorporeal CPR (8 vs. 13%, p < 0.05) increased after CAC accreditation. Likelihood of favorable neurological status at discharge was higher after CAC accreditation (71 vs. 87%, p < 0.01), whereas overall survival remained similar (35 vs. 35%, p > 0.99). CONCLUSION CAC accreditation is linked to higher rates of favorable neurological outcome and unchanged overall survival.
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Affiliation(s)
- Fabian Voß
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Tharusan Thevathasan
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité - Universitätsmedizin Berlin (Campus Benjamin Franklin), Hindenburgdamm 30, 12203 Berlin, Germany; Berlin Institute of Health, Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Karl Heinrich Scholz
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Georg August University of Göttingen, Robert-Koch-Straße 40, 34075 Göttingen, Germany
| | - Bernd W Böttiger
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Daniel Scheiber
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Payam Kabiri
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité - Universitätsmedizin Berlin (Campus Benjamin Franklin), Hindenburgdamm 30, 12203 Berlin, Germany
| | - Michael Bernhard
- Emergency Department, University Hospital, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany
| | - Peter Kienbaum
- Department of Anaesthesiology, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany; Abiomed Europe GmbH Europe, Neunhofer Weg 3, 52074 Aachen, Germany.
| | - Carsten Skurk
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charité - Universitätsmedizin Berlin (Campus Benjamin Franklin), Hindenburgdamm 30, 12203 Berlin, Germany
| | - Christoph Adler
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Cardiology, Kerpener Str. 62, 50937 Cologne, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225 Düsseldorf, Germany; CARID (Cardiovascular Research Institute Düsseldorf), Germany
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2
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Jung P, Brenner S, Bachmann I, Both C, Cardona F, Dohna-Schwake C, Eich C, Eifinger F, Huth R, Heimberg E, Landsleitner B, Olivieri M, Sasse M, Weisner T, Wagner M, Warnke G, Ziegler B, Boettiger BW, Nadkarni V, Hoffmann F. Mehr als 500 Kinder pro Jahr könnten gerettet werden! Zehn Thesen zur Verbesserung der Qualität pädiatrischer Reanimationen im deutschsprachigen Raum. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01546-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3
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Scholz KH, Busch HJ, Frey N, Kelm M, Rott N, Thiele H, Böttiger BW. Qualitätskriterien und strukturelle Voraussetzungen für Cardiac Arrest Zentren – Update 2021. DER KARDIOLOGE 2021. [PMCID: PMC8591966 DOI: 10.1007/s12181-021-00517-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- K. H. Scholz
- Medizinische Klinik I, Kardiologie u. Intensivmedizin, St. Bernward-Krankenhaus Hildesheim, Treibestraße 9, 31134 Hildesheim, Deutschland
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
| | - H. J. Busch
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - N. Frey
- Deutsche Gesellschaft für Kardiologie – Herz und Kreislaufforschung e. V. (DGK), Düsseldorf, Deutschland
- Klinik für Kardiologie, Angiologie und Pneumologie, Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M. Kelm
- Deutsche Gesellschaft für Kardiologie – Herz und Kreislaufforschung e. V. (DGK), Düsseldorf, Deutschland
- Herz- und Gefäßzentrum, Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - N. Rott
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Köln, Deutschland
| | - H. Thiele
- Deutsche Gesellschaft für Kardiologie – Herz und Kreislaufforschung e. V. (DGK), Düsseldorf, Deutschland
- Herzzentrum Leipzig, Universität Leipzig, Leipzig, Deutschland
| | - B. W. Böttiger
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Köln, Deutschland
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4
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Scholz KH, Busch HJ, Frey N, Kelm M, Rott N, Thiele H, Böttiger BW. [Quality indicators and structural requirements for Cardiac Arrest Centers-Update 2021]. Notf Rett Med 2021; 24:826-830. [PMID: 34276249 PMCID: PMC8275904 DOI: 10.1007/s10049-021-00920-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/28/2022]
Abstract
Es handelt sich hierbei um ein Update der im Frühjahr 2017 erstmals beschriebenen Qualitätskriterien und strukturellen Voraussetzungen für Cardiac Arrest Zentren auf Basis der ersten Zertifizierungen und Erfahrungen. Die Kriterien wurden angepasst und konkretisiert und zum Teil zur Umsetzbarkeit im klinischen Alltag neu definiert.
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Affiliation(s)
- K H Scholz
- Medizinische Klinik I, Kardiologie u. Intensivmedizin, St. Bernward-Krankenhaus Hildesheim, Treibestraße 9, 31134 Hildesheim, Deutschland.,Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
| | - H J Busch
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland.,Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - N Frey
- Klinik für Kardiologie, Angiologie und Pneumologie, Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Kelm
- Herz- und Gefäßzentrum, Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - N Rott
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland.,Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Köln, Deutschland
| | - H Thiele
- Herzzentrum Leipzig, Universität Leipzig, Leipzig, Deutschland
| | - B W Böttiger
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland.,Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Köln, Deutschland
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5
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Nee J, Koerner R, Zickler D, Schroeder T, Enghard P, Nibbe L, Hasper D, Buder R, Leithner C, Ploner CJ, Eckardt KU, Storm C, Kruse JM. Establishment of an extracorporeal cardio-pulmonary resuscitation program in Berlin - outcomes of 254 patients with refractory circulatory arrest. Scand J Trauma Resusc Emerg Med 2020; 28:96. [PMID: 32972428 PMCID: PMC7513459 DOI: 10.1186/s13049-020-00787-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
Objective Optimal management of out of hospital circulatory arrest (OHCA) remains challenging, in particular in patients who do not develop rapid return of spontaneous circulation (ROSC). Extracorporeal cardiopulmonary resuscitation (eCPR) can be a life-saving bridging procedure. However its requirements and feasibility of implementation in patients with OHCA, appropriate inclusion criteria and achievable outcomes remain poorly defined. Design Prospective cohort study. Setting Tertiary referral university hospital center. Patients Here we report on characteristics, course and outcomes on the first consecutive 254 patients admitted between August 2014 and December 2017. Intervention eCPR program for OHCA. Mesurements and main results A structured clinical pathway was designed and implemented as 24/7 eCPR service at the Charité in Berlin. In total, 254 patients were transferred with ongoing CPR, including automated chest compression, of which 30 showed or developed ROSC after admission. Following hospital admission predefined in- and exclusion criteria for eCPR were checked; in the remaining 224, 126 were considered as eligible for eCPR. State of the art postresuscitation therapy was applied and prognostication of neurological outcome was performed according to a standardized protocol. Eighteen patients survived, with a good neurological outcome (cerebral performance category (CPC) 1 or 2) in 15 patients. Compared to non-survivors survivors had significantly shorter time between collaps and start of eCPR (58 min (IQR 12–85) vs. 90 min (IQR 74–114), p = 0.01), lower lactate levels on admission (95 mg/dL (IQR 44–130) vs. 143 mg/dL (IQR 111–178), p < 0.05), and less severe acidosis on admission (pH 7.2 (IQR 7.15–7.4) vs. 7.0 (IQR6.9–7.2), p < 0.05). Binary logistic regression analysis identified latency to eCPR and low pH as independent predictors for mortality. Conclusion An eCPR program can be life-saving for a subset of individuals with refractory circulatory arrest, with time to initiation of eCPR being a main determinant of survival.
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Affiliation(s)
- Jens Nee
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Roland Koerner
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Daniel Zickler
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Tim Schroeder
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Philipp Enghard
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Lutz Nibbe
- Department of Emergency and Intensive Care Medicine, Ernst von Bergmann Klinikum, Charlottenstraße 72, 14467, Potsdam, Germany
| | - Dietrich Hasper
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Robert Buder
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christoph Leithner
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christoph J Ploner
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christian Storm
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Jan M Kruse
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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6
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Jung P, Brenner S, Bachmann I, Both C, Cardona F, Dohna-Schwake C, Eich C, Eifinger F, Huth R, Heimberg E, Landsleitner B, Olivieri M, Sasse M, Weisner T, Wagner M, Warnke G, Ziegler B, Boettiger BW, Nadkarni V, Hoffmann F. More Than 500 Kids Could Be Saved Each Year! Ten Consensus Actions to Improve Quality of Pediatric Resuscitation in DACH-Countries (Austria, Germany, and Switzerland). Front Pediatr 2020; 8:549710. [PMID: 33117762 PMCID: PMC7575775 DOI: 10.3389/fped.2020.549710] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/31/2020] [Indexed: 12/21/2022] Open
Abstract
• Quality and outcome of pediatric resuscitation often does not achieve recommended goals. • Quality improvement initiatives with the aim of better survival rates and decreased morbidity of resuscitated children are urgently needed. • These initiatives should include an action framework for a comprehensive, fundamental, and interprofessional reorientation of clinical and organizational structures concerning resuscitation and post-resuscitation care of children. • The authors of this DACH position statement suggest the implementation of 10 evidence-based actions (for out-of-hospital and in-house cardiac arrests) that should improve survival rates and decrease morbidity of resuscitated children with better neurological outcome and quality of life.
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Affiliation(s)
- Philipp Jung
- University Children's Hospital, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Sebastian Brenner
- Neonatology and Pediatric Intensive Care, University Hospital Carl Gustav Carus, University of Dresden, Dresden, Germany
| | - Iris Bachmann
- University Children's Hospital Zürich, Zurich, Switzerland
| | - Christian Both
- University Children's Hospital Zürich, Zurich, Switzerland
| | - Francesco Cardona
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Christoph Eich
- Department of Anaesthesia, Pediatric Intensive Care and Emergency Medicine, Auf der Bult Children's Hospital, Hanover, Germany
| | | | - Ralf Huth
- University Children's Hospital, Mainz, Germany
| | - Ellen Heimberg
- Department of Pediatric Cardiology, Pulmology and Intensive Care Medicine, University Children's Hospital, Tuebingen, Germany
| | | | - Martin Olivieri
- Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Sasse
- University Children's Hospital, Medical School Hannover, Hanover, Germany
| | - Thomas Weisner
- University Children's Hospital, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Michael Wagner
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Gert Warnke
- University Children's Hospital Graz, Graz, Austria
| | | | - Bernd W Boettiger
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Vinay Nadkarni
- Children's Hospital of Philadelphia, University of Pennsylvania Perlman School of Medicine, Philadelphia, PA, United States
| | - Florian Hoffmann
- Dr. von Hauner University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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7
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Storm C, Behringer W, Wolfrum S, Michels G, Fink K, Kill C, Arrich J, Leithner C, Ploner C, Busch HJ. [Postcardiac arrest treatment guide]. Med Klin Intensivmed Notfmed 2019; 115:573-584. [PMID: 31197420 DOI: 10.1007/s00063-019-0591-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/28/2019] [Accepted: 05/06/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Treatment after cardiac arrest has become more complex and interdisciplinary over the last few years. Thus, the clinically active intensive and emergency care physician not only has to carry out the immediate care and acute diagnostics, but also has to prognosticate the neurological outcome. AIM The different, most important steps are presented by leading experts in the area, taking into account the interdisciplinarity and the currently valid guidelines. MATERIALS AND METHODS Attention was paid to a concise, practice-oriented presentation. RESULTS AND DISCUSSION The practical guide contains all important steps from the acute care to the neurological prognosis generation that are relevant for the clinically active intensive care physician.
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Affiliation(s)
- C Storm
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - W Behringer
- Zentrum für Notfallmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - S Wolfrum
- Interdisziplinäre Notaufnahme, Universitätsklinikum Lübeck, Lübeck, Deutschland
| | - G Michels
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Köln, Deutschland
| | - K Fink
- Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Straße, 79106, Freiburg Breisgau, Deutschland
| | - C Kill
- Zentrum für Notfallmedizin, Universitätsklinikum Essen, Essen, Deutschland
| | - J Arrich
- Zentrum für Notfallmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - C Leithner
- Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - C Ploner
- Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Sir-Hans-A.-Krebs-Straße, 79106, Freiburg Breisgau, Deutschland.
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