Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · May 2024
Review[The Myth about the Laryngeal Mask].
Peak pressures ≥ 20 mbar are not a contraindication for laryngeal masks. The oropharyngeal leak pressure of a laryngeal mask does not correspond to the pressure at which oesophagogastric air leakage occurs. ⋯ A good alternative is to use a pressure alarm limit. The use of laryngeal masks does not preclude the use of PEEP and/or relaxation.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2024
Review[Practice Guidelines for Central Venous Access 2020 - Time for German Guidelines].
The American Society of Anesthesiologists released practice guidelines for central venous access in 2020, and the entire world literature was examined for evidence on how to perform the entire process with best practice and minimal risk and harm to the patient. These guidelines may serve as a gold standard for individual procedural steps, allowing practitioners and hospital departments to critically question the own standard and improve upon them. We interpreted the guidelines for individual procedural steps on how to improve success of catheterization, minimize risks or adverse effects, enhance the management of accidental arterial punctures, adhere to evidence-based practices, and generally reduce the trauma of puncturing. ⋯ In our view, it is time to implement a national guideline for central venous access using ultrasound in Germany. Doing so may improve success rates in the first attempt, reduce procedural time, decrease the number of needle insertions per patient, and lower the rate of arterial punctures. This approach represents best practice from ethical, insurance, civil rights, and patient security perspectives, and is supported by relevant societies.
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After successful resuscitation, further treatment has a decisive influence regarding patient outcome. Not only overall survival, but also the neurological outcome that is crucial for patients' quality of life can be positively influenced by optimized post-cardiac arrest treatment. ⋯ The immediate treatment and stabilization of patients after ROSC is followed by the diagnosis of the triggering pathology in order to initiate adequate therapy. During the subsequent intensive care treatment, the focus is on optimizing neurological recovery.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2024
Review[Resuscitation Update - What's New?].
Perfect, uninterrupted basic life support (BLS) is the key for successful cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA). Time plays an important role in the treatment of OHCA. This applies both to the time until the start of BLS and the reduction of all pauses during resuscitation, especially chest compressions. ⋯ In refractory OHCA, extracorporeal CPR should be considered. In the case of in-hospital cannulation, immediate transport should be weighed against impaired chest compression quality. Therefore, transportation under CPR is only beneficial if there is an indication for further treatment.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Apr 2024
Review[Extracorporeal Cardiopulmonary Resuscitation(ECPR) - the Future?].
In recent years, invasive resuscitation methods utilizing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) have gained significant attention. Despite advances in traditional resuscitation measures, out-of-hospital cardiac arrest (OHCA) mortality remains high. In the context of extracorporeal cardiopulmonary resuscitation (ECPR), VA-ECMO therapy offers a promising approach by providing circulatory support during cardiac arrest, allowing time for diagnostic evaluation and targeted therapy. ⋯ Early studies indicate promising outcomes with CARL therapy, emphasizing the importance of a well-coordinated and structured approach to ECPR implementation. In summary, ECPR shows promise in improving survival rates for OHCA patients within a well-organized healthcare system. However, further research is needed to refine patient selection criteria and optimize treatment protocols, ultimately enhancing patient outcomes in cardiac arrest scenarios.