retrospective investigation of success rates with regard to the application of enoximone

Einleitung: Die kardiopulmonale Reanimation stellt bei Kindern eine seltene Extremsituation dar. Dennoch sind fundierte Entscheidungen unbedingt erforderlich. Die ERC-Leitlinie gibt einen Handlungsalgorithmus in einer Arrestsituation beim pädiatrischen Patienten vor. Hierbei wird der Einsatz von Adrenalin als Standardmedikation empfohlen. Amiodaron bleibt der kardiopulmonalen Reanimation bei einem defibrillierbaren Rhythmus vorbehalten. Natriumbikarbonat, Kalzium und Magnesium hingegen sind erst in besonderen Situationen indiziert. In vielen Fällen werden zusätzlich Medikamente als individueller Heilversuch nach erfolgloser Reanimation eingesetzt. Hierzu zählt unter anderem das Enoximone. Zielsetzung: Unter besonderer Berücksichtigung des Enoximone sollten die Maßnahmen und deren Erfolg sowie die Auswirkungen begleitender Parameter auf die Endpunkte „Erreichen eines spontanen Kreislaufs“ und „neurokognitives Outcome“ - mittels „Glasgow Outcome Scale“ (GOS) - im Rahmen der kardiopulmonalen Reanimation untersucht werden. Methodik: Alleiniges Einschlusskriterium war eine Reanimation im Zeitraum 2000 bis 2010 auf der Intensivstation der Kliniken für Pädiatrie der Charité - Campus Virchow Klinikum oder auswärts mit unmittelbar folgender Einlieferung. Hierzu wurden retrospektiv entsprechende Patienten mittels Logbuch der Intensivstation sowie der elektronischen Patientenerfassung des SAP-Systems rekrutiert. Ergebnisse: Insgesamt wurden 145 Patienten eingeschlossen. Bei 31,7 % der Patienten wurde eine Reanimation außerhalb des Krankenhauses begonnen. Die meisten Kreislaufstillstände waren respiratorisch bedingt. 80 % aller Patienten waren zum Zeitpunkt des Arrests vorerkrankt. 83,4 % aller Patienten erreichten einen spontanen Kreislauf. Patienten mit Erreichen eines spontanen Kreislaufs wurden häufiger innerhalb des Krankenhauses und kürzer reanimiert. Nach jeder Maßnahme, entsprechend des Algorithmus, erreichten mehr Patienten einen spontanen Kreislauf. Nach Ablauf des Algorithmus war die Rate eines erreichten spontanen Kreislaufs der Gesamtkohorte 71,7 % und nach der zusätzlichen Enoximoneapplikation 83,4 %. Insgesamt erreichten 26,8 % der Patienten ein GOS 4/5. Diese wurden im Vergleich zu Patienten mit einem GOS 1-3 kürzer reanimiert. Patienten mit einem GOS 4/5 erhielten in 15,2 % der Fälle Enoximone. Alle überlebenden Patienten mit Enoximone erreichten ein GOS 4/5. Schlussfolgerung: Die Rate eines erreichten spontanen Kreislaufs ohne Enoximone lag im Bereich bisher publizierter Daten in Kohorten mit ähnlicher Patientenzusammensetzung. Die mit Enoximone erreichte Rate spontaner Kreisläufe lag um mehr als 10 % über den Raten bisheriger Arbeiten. Von den Patienten, die mit Enoximone überlebten, erreichten alle ein GOS 4/5. Diese Daten deuten auf einen vorteilhaften Effekt von Enoximone in der kardiopulmonalen Reanimation von Kindern hin. Auf Grundlage der vorgelegten Daten müssten prospektive Studien diesen Effekt bestätigen, um letztendlich eine Enoximonegabe in den Reanimationsalgorithmus aufnehmen zu können.Background: Pediatric cardiopulmonary arrest is rare and poses an extreme situation. Nevertheless, well-founded decisions are required. The guideline of the ERC shows an algorithm explaining necessary measures during cardiopulmonary resuscitation (CPR) in children. Standardly, adrenaline is given. Amiodarone remains reserved when having a shockable rhythm. In contrast, sodium bicarbonate, calcium and magnesium are only indicated in definite situations. Sometimes, additional medications are applied as an expanded access following an unsuccessful resuscitation. One of these medications is enoximone. Objective: Aiming the evaluation of measures considering the application of enoximone during CPR, their success and effects together with additional parameters should be investigated with regard to “return of a spontaneous circulation” (ROSC) and “neurocognitive outcome” - using the “Glasgow Outcome Scale” (GOS). Methods: All patients with a CPR during the time period 2000 to 2010 at the intensive care unit of the children’s hospital Charité - Campus Virchow Klinikum or an out-of-hospital cardiac arrest with an immediate admission were included. Matching patients were recruited retrospectively by use of the logbook of the intensive care unit and SAP system. Results: Altogether, 145 patients were included. 31.7 % of the patients had a beginning CPR outside of the hospital. Most of the patients had a respiratory induced arrest. 80 % of all patients had preexisting illnesses. 83.4 % of all patients achieved a ROSC. Patients with ROSC were resuscitated more often inside the hospital and had a shorter duration of CPR. After every measure - according to the algorithm - increasingly more patients reached a ROSC. At the end of the algorithm the rate of ROSC accounted 71.7 %. After the additional application of enoximone 83.4 % ROSC was realized. Altogether, 26.8 % of the patients achieved a GOS 4/5. Patients with a GOS 4/5 had a shorter duration of resuscitation than patients with a GOS 1-3. 15.2 % of the patients with a GOS 4/5 received enoximone. Every surviving patient who got enoximone had a GOS 4/5. Conclusion: The rate of achieved ROSC without enoximone matched to previous findings having a similar compound of patients. After the application of enoximone more than additional 10 % reached a ROSC. Each surviving patient with enoximone achieved a GOS 4/5. These results suggest a beneficial effect of the application of enoximone during CPR in children. Further studies are required to evaluate the role of enoximone in pediatric CPR and an implementation into existing guidelines

Structured reporting of head and neck ultrasound examinations

Abstract Background Reports of head and neck ultrasound examinations are frequently written by hand as free texts. Naturally, quality and structure of free text reports is variable, depending on the examiner’s individual level of experience. Aim of the present study was to compare the quality of free text reports (FTR) and structured reports (SR) of head and neck ultrasound examinations. Methods Both standard FTRs and SRs of head and neck ultrasound examinations of 43 patients were acquired by nine independent examiners with comparable levels of experience. A template for structured reporting of head and neck ultrasound examinations was created using a web-based approach. FTRs and SRs were evaluated with regard to overall quality, completeness, required time to completion, and readability by four independent raters with different specializations (Paired Wilcoxon test, 95% CI) and inter-rater reliability was assessed (Fleiss’ kappa). A questionnaire was used to compare FTRs vs. SRs with respect to user satisfaction (Mann-Whitney U test, 95% CI). Results By comparison, completeness scores of SRs were significantly higher than FTRs’ completeness scores (94.4% vs. 45.6%, p < 0.001), and pathologies were described in more detail (91.1% vs. 54.5%, p < 0.001). Readability was significantly higher in all SRs when compared to FTRs (100% vs. 47.1%, p < 0.001). The mean time to complete a report, however, was significantly higher in SRs (176.5 vs. 107.3 s, p < 0.001). SRs achieved significantly higher user satisfaction ratings (VAS 8.87 vs. 1.41, p < 0.001) and a very high inter-rater reliability (Fleiss’ kappa 0.92). Conclusions As compared to FTRs, SRs of head and neck ultrasound examinations are more comprehensive and easier to understand. On the balance, the additional time needed for completing a SR is negligible. Also, SRs yield high inter-rater reliability and may be used for high-quality scientific data analyses

Structured reporting of head and neck ultrasound examinations

Abstract Background Reports of head and neck ultrasound examinations are frequently written by hand as free texts. Naturally, quality and structure of free text reports is variable, depending on the examiner’s individual level of experience. Aim of the present study was to compare the quality of free text reports (FTR) and structured reports (SR) of head and neck ultrasound examinations. Methods Both standard FTRs and SRs of head and neck ultrasound examinations of 43 patients were acquired by nine independent examiners with comparable levels of experience. A template for structured reporting of head and neck ultrasound examinations was created using a web-based approach. FTRs and SRs were evaluated with regard to overall quality, completeness, required time to completion, and readability by four independent raters with different specializations (Paired Wilcoxon test, 95% CI) and inter-rater reliability was assessed (Fleiss’ kappa). A questionnaire was used to compare FTRs vs. SRs with respect to user satisfaction (Mann-Whitney U test, 95% CI). Results By comparison, completeness scores of SRs were significantly higher than FTRs’ completeness scores (94.4% vs. 45.6%, p < 0.001), and pathologies were described in more detail (91.1% vs. 54.5%, p < 0.001). Readability was significantly higher in all SRs when compared to FTRs (100% vs. 47.1%, p < 0.001). The mean time to complete a report, however, was significantly higher in SRs (176.5 vs. 107.3 s, p < 0.001). SRs achieved significantly higher user satisfaction ratings (VAS 8.87 vs. 1.41, p < 0.001) and a very high inter-rater reliability (Fleiss’ kappa 0.92). Conclusions As compared to FTRs, SRs of head and neck ultrasound examinations are more comprehensive and easier to understand. On the balance, the additional time needed for completing a SR is negligible. Also, SRs yield high inter-rater reliability and may be used for high-quality scientific data analyses