Recent Trends of Studies and Surveys on Area Activation

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Zusammensetzung von Schockraumteams : Gelebte Realität in 12 überregionalen Traumazentren

HINTERGRUND: Die Bereitstellung spezialisierter Schockraumteams zur Schwerverletztenversorgung ist nach den Vorgaben der S3-Leitlinie Polytrauma/Schwerverletztenversorgung der AMWF obligat und die Zusammensetzung durch das Weißbuch Schwerverletztenversorgung festgelegt. In jeder Versorgungsstufe wird das Basisteam aus den 4 Disziplinen Orthopädie und Unfallchirurgie, Anästhesie, Radiologie und der Notfallpflege der Notaufnahme zusammengesetzt, mit weiteren Anpassungen je nach Versorgungsstufe des Krankenhauses. Ziel der vorliegenden Studie ist die Untersuchung der gelebten Realität bei der Zusammensetzung der Schockraumteams. METHODIK: Bei der prospektiven, multizentrischen Beobachtungsstudie wurden in 12 überregionalen Traumazentren in Deutschland und der Schweiz insgesamt 3753 Patienten nach Unfällen in der Notaufnahme behandelt, darunter 964 Patienten (26 %) nach vorangegangener Schockraumalarmierung. ERGEBNISSE: In 94,7 % der Schockraumversorgungen waren alle 4 der geforderten Disziplinen anwesend; im Durchschnitt waren 6 Personen an der Schockraumversorgung beteiligt. Die 48-h-Mortalität betrug 3 % der über den Schockraum versorgten Patienten; bei allen verstorbenen Patienten waren während der Schockraumversorgung alle 4 Disziplinen anwesend. Bei Patienten mit mindestens einem Alarmierungskriterium der Kategorie A waren bei 97,7 % der Versorgung ein vollständiges Team aus 4 Disziplinen an der Versorgung beteiligt. DISKUSSION: In fast 98 % der Fälle, in denen Alarmierungskriterien der Kategorie A vorliegen, sind alle 4 der im Weißbuch geforderten Disziplinen zur Patientenversorgung im Schockraum anwesend. Dies geht mit einer mittleren Ressourcenbindung von 6,6 Personen einher. Das Fehlen einer oder mehrerer Disziplinen bei der Schockraumversorgung scheint die frühe Mortalität der Schwerverletzten nicht signifikant zu beeinflussen. // BACKGROUND: The provision of specialized trauma teams for the care of severely injured patients is mandatory according to the requirements of the S3 guidelines polytrauma and the composition is determined by the White Book Medical Care of the Severely Injured (Weißbuch Schwerverletztenversorgung). In each level of care the basic resuscitation room team is composed of four disciplines: orthopedics and trauma surgery, anesthesia, radiology and emergency medicine in the emergency department. MATERIAL AND METHODS: A prospective, multicenter observational study was conducted in 12 supraregional trauma centers in Germany and Switzerland, where a total of 3753 patients were treated in the emergency department following accidents. Amongst them 964 patients (26%) were treated after prior trauma team activation. RESULTS: In 94.7% of the trauma room care instances all 4 required disciplines were present, with an average of 6.6 individuals involved in the trauma room care. The 48‑h mortality rate was 3% among patients receiving trauma room care. In all deceased patients, all four disciplines were present during the trauma room care. At least one or more high-risk criteria for serious injuries were present in 40.8% of the patients. In these cases, a complete team consisting of all 4 disciplines was involved in 97.7% of the care instances. CONCLUSION: In nearly 98% of cases where high-risk criteria for serious injuries (category A activation criteria) all 4 required disciplines were present in the trauma room for patient care. This was associated with an average resource commitment of 6.6 individuals. The absence of one or more disciplines in trauma room care does not appear to significantly affect early mortality in the severely injured

ACTIVATION (PercutAneous Coronary inTervention prIor to transcatheter aortic VAlve implantaTION): A Randomized Clinical Trial.

OBJECTIVES: This study sought to determine if percutaneous coronary intervention (PCI) prior to transcatheter aortic valve replacement (TAVR) in patients with significant coronary artery disease would produce noninferior clinical results when compared with no PCI (control arm). BACKGROUND: PCI in patients undergoing TAVR is not without risk, and there are no randomized data to inform clinical practice. METHODS: Patients with severe symptomatic aortic stenosis and significant coronary artery disease with Canadian Cardiovascular Society class ≤2 angina were randomly assigned to receive PCI or no PCI prior to TAVR. The primary endpoint was a composite of all-cause death or rehospitalization at 1 year. Noninferiority testing (prespecified margin of 7.5%) was performed in the intention-to-treat population. RESULTS: At 17 centers, 235 patients underwent randomization. At 1 year, the primary composite endpoint occurred in 48 (41.5%) of the PCI arm and 47 (44.0%) of the no-PCI arm. The requirement for noninferiority was not met (difference: -2.5%; 1-sided upper 95% confidence limit: 8.5%; 1-sided noninferiority test P = 0.067). On analysis of the as-treated population, the difference was -3.7% (1-sided upper 95% confidence limit: 7.5%; P = 0.050). Mortality was 16 (13.4%) in the PCI arm and 14 (12.1%) in the no-PCI arm. At 1 year, there was no evidence of a difference in the rates of stroke, myocardial infarction, or acute kidney injury, with higher rates of any bleed in the PCI arm (P = 0.021). CONCLUSIONS: Observed rates of death and rehospitalization at 1 year were similar between PCI and no PCI prior to TAVR; however, the noninferiority margin was not met, and PCI resulted in a higher incidence of bleeding. (Assessing the Effects of Stenting in Significant Coronary Artery Disease Prior to Transcatheter Aortic Valve Implantation; ISRCTN75836930)