Background-Active compression-decompression (ACD) CPR combined with an inspiratory impedance threshold device (ITD) improves vital organ blood flow during cardiac arrest. This study compared survival rates with ACDϩITD CPR versus standard manual CPR (S-CPR). Methods and Results-A prospective, controlled trial was performed in Mainz, Germany, in which a 2-tiered emergency response included early defibrillation. Patients with out-of-hospital arrest of presumed cardiac pathogenesis were sequentially randomized to ACDϩITD CPR or S-CPR by the advanced life support team after intubation. Rescuers learned which method of CPR to use at the start of each work shift. The primary end point was 1-hour survival after a witnessed arrest. With ACDϩITD CPR (nϭ103), return of spontaneous circulation and 1-and 24-hour survival rates were 55%, 51%, and 37% versus 37%, 32%, and 22% with S-CPR (nϭ107) (Pϭ0.016, 0.006, and 0.033, respectively). One-and 24-hour survival rates in witnessed arrests were 55% and 41% with ACDϩITD CPR versus 33% and 23% in control subjects (Pϭ0.011 and 0.019), respectively. One-and 24-hour survival rates in patients with a witnessed arrest in ventricular fibrillation were 68% and 58% after ACDϩITD CPR versus 27% and 23% after S-CPR (Pϭ0.002 and 0.009), respectively. Patients randomized Ն10 minutes after the call for help to the ACDϩITD CPR had a 3 times higher 1-hour survival rate than control subjects (Pϭ0.002). Hospital discharge rates were 18% after ACDϩITD CPR versus 13% in control subjects (Pϭ0.41). In witnessed arrests, overall neurological function trended higher with ACDϩITD CPR versus control subjects (Pϭ0.07). Conclusions-Compared with S-CPR, ACDϩITD CPR significantly improved short-term survival rates for patients with out-of-hospital cardiac arrest. Additional studies are needed to evaluate potential long-term benefits of ACDϩITD CPR.

Our report includes, to our knowledge, the longest documented treatment course of symptomatic rabies and the first time that the virus concentration was measured over time and in different body compartments. The postmortem virus concentration in the periphery was low, but there was no evidence of a reduction of virus in the brain.

Summary The number of potential organ donors depends on various factors, among which the number of deceased with primary or secondary brain damage is the most decisive. In the north‐east donor region of Germany with 7.69 million inhabitants, 2019 cases of deceased with primary or secondary brain damage were reported by 136 intensive care units during 2002–2005. In a study, 64% of these deceased were identified as potential donors. This represents 40.7 potential donors per million inhabitants. It can be concluded that in the other donor regions of Germany a comparable number of potential donors exists, yet not all possible donors are being detected and referred. The conversion rate (percentage of potential donors who become effective donors) in the years 2002–2005 was 47%. The main reason for the conversion rate being so low was the large number of relatives who declined an organ donation (73%). More than 90% of the relatives in the north‐east region did not know the deceased's will in the acute situation. From our point of view the high refusal rate can be decreased mainly by two measures: improvement of the family approach and integrating the topic of organ donation into schools’ curricula.

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Pneumatic tube systems (PTS) present a convenient way for blood sample transport in medical facilities. Associated preanalytical interference in various tests is largely unknown. Implementing point-of-care coagulation management at our institution, we investigated multiple electrode aggregometry (MEA) and rotational thromboelastometry (ROTEM) after PTS transportation. Whole blood samples from patients undergoing general or trauma surgery were analysed by MEA after collection (baseline, '0 × PTS') and sent on a predefined PTS track (n = 12). MEA was repeated after samples travelled the track 4 ('4 × PTS'), 8 ('8 × PTS') and 12 times ('12 × PTS') and compared with stationary controls analysed at the same time. Samples for ROTEM (n = 6) were analysed after collection and travelling the track 12 times. An acceleration detector recorded g-forces on the PTS track. At '0 × PTS' no significant differences in MEA results were detected. Values were significantly lower for transported samples compared with controls ('4 × PTS' to '12 × PTS', p < 0.001). Furthermore, MEA results of PTS samples were significantly decreased for '4 × PTS' to '12 × PTS' compared to baseline (p < 0.001). Except for the clotting time in EXTEM PTS transport did not significantly alter results for investigated ROTEM parameters, compared with baseline and stationary controls. Acceleration detector readout revealed alternating g-forces between -6.3 and +5.9 during transport. PTS transport caused invalid results in MEA while only one ROTEM parameter was found to be affected in this study. Variable acceleration during transport provides a potential reason for platelet activation. The authors recommend sample transport by hand or the device to be placed patient-side when MEA is performed.

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