BackgroundNoninvasive regional cerebral oxygen saturation (rSO2) measurement using near-infrared spectroscopy (NIRS) might inform on extent and duration of cerebral hypoxia during cardiopulmonary resuscitation (CPR). This information may be used to guide resuscitation efforts and may carry relevant early prognostic information.MethodsWe prospectively investigated non-traumatic out-of-hospital cardiac arrest (OHCA) patients on scene. NIRS was started either during CPR or shortly after (<2 min) return of spontaneous circulation (ROSC) by emergency medical service (EMS). Outcome was determined at intensive care unit (ICU) discharge and 6 months after cardiac arrest.ResultsA total of 29 OHCA patients were included. In 23 patients NIRS was started during CPR and in 6 patients immediately after ROSC. 18 (62.1 %) patients did not reach ROSC. Initial rSO2 during CPR was very low (<50 % in all 23 patients, < 30 % in 19 of 23 patients) with no significant difference between patients achieving ROSC and those who did not. Of five patients with ROSC, in whom NIRS was recorded during CPR, two reached a good six-months outcome (initial rSO2 22 %) and three died during the ICU stay (initial rSO2 15, 16 and 46 %). In six patients with NIRS started immediately after ROSC (<2 min), rSO2 was substantially higher (54–85 %) than in patients during CPR (p = 0.006).Discussion and conclusionInitial frontal brain rSO2 determined by NIRS during CPR was generally very low and recovered rapidly after ROSC. Very low initial rSO2 during CPR was compatible with good neurological outcome in our limited cohort of patients. Further studies are needed to assess in larger cohorts and more detail the implications of very low initial rSO2 during CPR on scene.
Zusammenfassung
Einführung Die Implementierung der Notfallsanitäter*innenausbildung 2014
veränderte den Rettungsdienst nachhaltig. Es existieren keine wissenschaftlichen
Erkenntnisse zur curricularen Schwerpunktsetzung.
Methodik Es wurde eine retrospektive Datenanalyse praktischer
Prüfungsprotokolle von staatlichen Prüfungen, die von Rettungsassistent*innen
zwischen 2015–2018 abgelegt wurden, durchgeführt.
Ergebnisse Die praktischen Prüfungsergebnisse von 123 Teilnehmenden wurden
ausgewertet. Die traumatologischen Szenarien fielen mit einer Erfolgsrate von
77,2% am schlechtesten aus (internistisch 81,3%, Reanimation 83,7%, sonstige
82,9%). In Reanimationsszenarien führte u.a. die Verzögerung der Rhythmusanalyse
(21%) zu Mängeln, während in den restlichen Fallbeispielen die unsichere Nutzung
des ABCDE-Schemas das größte Problem darstellte (43% Trauma, 26%
internistisch).
Schlussfolgerung Nutzung des ABCDE-Schemas sowie die konsequente
Durchführung von Basismaßnahmen in der Reanimation sind Defizite des
Rettungsfachpersonals und sollten sich in der Schwerpunktsetzung der Ausbildung
wiederfinden.
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