COVID-19 CPR—Impact of Personal Protective Equipment during a Simulated Cardiac Arrest in Times of the COVID-19 Pandemic: A Prospective Comparative Trial

Background: Guidelines of cardiopulmonary resuscitation (CPR) recommend the use of personal protective equipment (PPE) during the resuscitation of COVID-19 patients. Data on the effects of PPE on rescuers’ stress level and quality of CPR are sparse and conflicting. This trial investigated the effects of PPE on team performance in simulated cardiac arrests. Methods: During the pandemic period, 198 teams (689 participants) performed CPR with PPE in simulated cardiac arrests (PPE group) and were compared with 423 (1451 participants) performing in identical scenarios in the pre-pandemic period (control group). Video recordings were used for data analysis. The primary endpoint was hands-on time. Secondary endpoints included a further performance of CPR and the perceived task load assessed by the NASA task-load index. Results: Hands-on times were lower in PPE teams than in the control group (86% (83–89) vs. 90% (87–93); difference 3, 95% CI for difference 3–4, p < 0.0001). Moreover, PPE teams made fewer change-overs and delayed defibrillation and administration of drugs. PPE teams perceived higher task loads (57 (44–67) vs. 63 (53–71); difference 6, 95% CI for difference 5–8, p < 0.0001) and scored higher in the domains physical and temporal demand, performance, and effort. Leadership allocation had no effect on primary and secondary endpoints. Conclusions: Having to wear PPE during CPR is an additional burden in an already demanding task. PPE is associated with an increase in perceived task load, lower hands-on times, fewer change-overs, and delays in defibrillation and the administration of drugs. (German study register number DRKS00023184)

U SO CARE-The Impact of Cardiac Ultrasound during Cardiopulmonary Resuscitation: A Prospective Randomized Simulator-Based Trial

Background: Actual cardiopulmonary resuscitation (CPR) guidelines recommend point-of-care ultrasound (POCUS); however, data on POCUS during CPR are sparse and conflicting. This randomized trial investigated the effects of POCUS during CPR on team performance and diagnostic accuracy. Methods: Intensive Care and Emergency Medicine residents performed CPR with or without available POCUS in simulated cardiac arrests. The primary endpoint was hands-on time. Data analysis was performed using video recordings. Results: Hands-on time was 89% (87-91) in the POCUS and 92% (89-94) in the control group (difference 3, 95% CI for difference 2-4, p < 0.001). POCUS teams had delayed defibrillator attachments (33 vs. 26 sec, p = 0.017) and first rhythm analysis (74 vs. 52 sec, p = 0.001). Available POCUS was used in 71%. Of the POCUS teams, 53 stated a POCUS-derived diagnosis, with 49 being correct and 42 followed by a correct treatment decision. Four teams made a wrong diagnosis and two made an inappropriate treatment decision. Conclusions: POCUS during CPR resulted in lower hands-on times and delayed rhythm analysis. Correct POCUS diagnoses occurred in 52%, correct treatment decisions in 44%, and inappropriate treatment decisions in 2%. Training on POCUS during CPR should focus on diagnostic accuracy and maintenance of high-quality CPR

Prevalence of SARS-COV-2 positivity in 516 German intensive care and emergency physicians studied by seroprevalence of antibodies National Covid Survey Germany (NAT-COV-SURV)

Healthcare personnel are at risk to aquire the corona virus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We evaluated the prevalence of SARS-CoV-2 antibodies and positive nasopharyngeal reverse transcriptase polymerase-chain reaction (RT-PCR) tests in German intensive care and emergency physicians. Physicians attending intensive care and emergency medicine training courses between June 16(th) and July 2(nd) 2020 answered a questionnaire and were screened for SARS-CoV-2 antibodies via automated electrochemiluminiscence immunoassay. We recruited 516 physicans from all parts of Germany, 445/516 (86%) worked in high risk areas, and 379/516 (73%) had treated patients with COVID-19. The overall positive rate was 18/516 (3.5%), 16/18 (89%) had antibodies against SARS-COV-2, another 2 reported previous positive RT-PCR results although antibody testing was negative. Of those positive, 7/18 (39%) were unaware of their infection. A stay abroad was stated by 173/498 (35%), mostly in Europe. 87/516 (17%) reported a febrile respiratory infection after January 1(st) 2020 which was related to SARS-CoV-2 in 4/87 (4.6%). Contact to COVID-19 positive relatives at home was stated by 22/502 (4.4%). This was the only significant risk factor for Covid-19 infection (Fisher ' s exact test, p = 0.0005). N95 masks and eye protection devices were available for 87% and 73%, respectively. A total of 254/502 (51%) had been vaccinated against seasonal influenza. The overall SARS-CoV-2 infection rate of german physicians from intensive care and emergency medicine was low compared to reports from other countries and settings. This finding may be explained by the fact that the German health care system was not overwhelmed by the first wave of the SARS-CoV-2 pandemic

THE USE OF DYNAMIC O-(2-[F-18]fluoroethyl)-L-TYROSINE-PET IN THE CLINICAL EVALUATION OF BRAIN TUMORS IN CHILDREN AND ADOLESCENTS

BACKGROUND: Experience regarding the use of dynamic O-(2-[(18)F]-fluoroethyl)-L-tyrosine ((18)F-FET) PET in children and adolescents with brain tumors is limited. METHODS: Sixty-nine (18)F-FET PET scans of 49 patients (median age, 13 years; range, 1-18 years) were analyzed retrospectively. Patients had been referred for: (A) assessment of newly diagnosed cerebral lesions (26 scans in 26 patients), (B) diagnosing tumor progression/recurrence (24 scans in 18 patients), (C) monitoring of chemotherapy effects (8 scans in 4 patients), and (D) the detection of residual tumor tissue after resection (11 scans in 10 patients). Maximum and mean tumor/brain ratios (TBR(max/mean)) of (18)F-FET uptake were determined (20-40 min p.i.) and time-activity curves were generated and assigned to one of the following patterns: (1) constantly increasing uptake, (2) uptake peaking at a midway point (>20-40 min) followed by a plateau, and (3) uptake peaking early (≤20 min) followed by a constant descent. The diagnostic values of TBRs and kinetic parameters to detect neoplastic tissue or diagnose tumor progression/recurrence were assessed using ROC analyses. Diagnoses were confirmed histologically and/or by clinical course. RESULTS: In patients with newly diagnosed cerebral lesions, highest accuracy (77%) to detect neoplastic tissue (7 of 26 patients) was obtained when TBR(max) was >1.7 (AUC, 0.80 ± 0.09; sensitivity, 79%; specificity, 71%, PPV, 88%; P = 0.02). For diagnosing tumor progression/recurrence, highest accuracy (82%) was obtained when curve patterns 2 or 3 were present (AUC, 0.80 ± 0.11; sensitivity, 75%; specificity, 90%, PPV, 90%; P = 0.02). During chemotherapy, a decrease of TBRs was associated with a stable clinical course at least for 6 months. In patients after complete tumor resection (2 of 10 patients), (18)F-FET PET detected metabolically active tumor (TBR(max) ≥ 1.7). CONCLUSIONS: Our findings suggest that (18)F-FET PET can add valuable information for clinical decision-making in pediatric brain tumor patients