Medizinische Klinik, Intensivmedizin und Notfallmedizin
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Med Klin Intensivmed Notfmed · Mar 2019
Review[New guidelines for the diagnosis of irreversible loss of brain function : Concept and limitations, organizational demands, and implementation].
In 2015, the German Medical Association (Bundesärztekammer) issued new guidelines on the diagnosis of the "irreversible loss of brain function" (ILBF). ILBF replaced the colloquial term "brain death" in order to leave the notion that concepts of death might vary such as "cardiac death" or "apparent death" and stress the objective medical-scientific matter. The German Transplantation Law describes ILBF as "the final, irreversible loss of all function of the cerebrum, cerebellum, and brainstem." The new guidelines are to be followed closely. ⋯ The new guidelines thereby raise the impact of demonstrating complete cerebral circulatory arrest but leave other options to prove irreversibility. Many procedures, such as the apnea test, were specified in more detail. This article summarizes the new features of the new guideline with a practical overview on who must be involved in the diagnosis of ILBF, how often, how the diagnosis is achieved stepwise from stage I to III and how it is secured as well as what technical methods may be involved at what stage of the procedure.
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Med Klin Intensivmed Notfmed · Mar 2019
Use of automated external defibrillators for in-hospital cardiac arrest : Any time, any place?
Acute treatment of in-hospital cardiac arrest (IHCA) is challenging and overall survival rates are low. However, data on the use of public-access automated external defibrillators (AEDs) for IHCA remain controversial. The aim of our study was to evaluate characteristics of patients experiencing IHCA and feasibility of public-access AED use for resuscitation in a university hospital. ⋯ AEDs were applied in less than 50% of the IHCA events. Furthermore, AED use was inadequate in the majority of the cases. Since adequate AED use is associated with improved survival, AEDs should be available in hospital areas with patients at high risk of shockable rhythm.
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The number of organ donors in Germany has been falling since 2010. In 2017, it reached its lowest level in 20 years with 797 organ donors. With 9.7 organ donors per million inhabitants, Germany lags far behind other European countries. ⋯ This is considered the best way to meet the patient's desire regarding organ donation. With reference to the dramatic development, DSO calls for a broad social debate and a joint initiative involving medical associations, contractors, patient associations and policymakers. Getting organ donation back on track in Germany for the benefit of patients on the waiting lists can only be achieved by a joint effort.