Tantric and Taoist Studies in Honour of R.A. Stein, Mèlanges chinois et bouddhiques, vol. XX

Ronald M. Davidson is a contributing author, “The Litany of Names of Mañjusri: Text and Translation of the Mañjusri-namasamgiti , pp. 1-69.https://digitalcommons.fairfield.edu/religiousstudies-books/1064/thumbnail.jp

Präklinische Post-Cardiac-Arrest-Sedierung und -Behandlung in der Bundesrepublik Deutschland – eine webbasierte Umfrage unter notärztlichem Personal

Jansen G, Latka E, Deicke M, et al. Präklinische Post-Cardiac-Arrest-Sedierung und -Behandlung in der Bundesrepublik Deutschland – eine webbasierte Umfrage unter notärztlichem Personal. Medizinische Klinik - Intensivmedizin und Notfallmedizin. 2023.Hintergrund Die Optimierung der Postreanimationsbehandlung (PRB) rückt in den letzten Jahren zunehmend in den Fokus und erfordert oft eine Post-Cardiac-Arrest-Sedierung (PCAS). Diese Studie evaluiert die Durchführung von PCAS und PRB von deutschen Notarzt*innen. Material und Methoden Auswertung einer Onlineumfrage von Oktober bis November 2022. Gefragt wurde nach Durchführung, eingesetzten Medikamenten, Komplikationen und Beweggründen für die Durchführung oder den Verzicht auf eine PCAS sowie nach Maßnahmen des PRB. Ergebnisse Insgesamt nahmen 500 Notarzt*innen an der Umfrage teil, wovon 367 (73,4 %) Teilnehmende eine PCAS durchführten (Hypnotika: 84,7 %; Analgetika: 71,1 %; ergänzt um Relaxanzien: 29,7 %). Beweggründe waren Pressen (88,3 %), Analgesie (74,1 %), Synchronisation an den Respirator (59,5 %) und Wechsel eines extraglottischen auf einen endotrachealen Atemweg (52,6 %). Bewegründe für den Verzicht waren Bewusstlosigkeit (73,7 %), Sorge vor Hypotonie (31,6 %) bzw. Re-Arrest (26,3 %) und Verschlechterung der neurologischen Beurteilbarkeit (22,5 %). Beobachtete Komplikationen (19,3 %) waren Hypotension (74,6 %) und Re-Arrest (32,4 %). Die PRB umfasste 12-Kanal-Elektrokardiogramm (96,6 %); Kapnographie (91,6 %); Katecholamingabe (77,6 %); Sonographie von Herz (20,6 %), Lungen (12,0 %) und Abdomen (5,6 %), Hypothermie (13,6 %) und Blutgasanalyse (7,4 %). Ein etCO2 von 35–45 mm Hg wurde von 203 (40,6 %), ein SpO2 von 94–98 % von 45 (9,0 %) und ein systolischer Blutdruck von ≥ 100 mm Hg von 194 (19,2 %) angestrebt. Diskussion Die präklinische PRB ist heterogen und Abweichungen von in den Leitlinien empfohlenen Zielparametern sind häufig. Eine PCAS erfolgt häufig und ist mit relevanten Komplikationen verbunden. Die Entwicklung von präklinischen Versorgungsalgorithmen für PCAS und PRB erscheint dringend erforderlich.Background This study evaluates the implementation of postcardiac-arrest-sedation (PCAS) and -care (PRC) by prehospital emergency physicians in Germany. Materials and methods Analysis of a web-based survey from October to November 2022. Questions were asked about implementation, medications used, complications, motivation for implementing or not implementing PCAS, and measures and target parameters of PRC. Results A total of 500 emergency physicians participated in the survey. In all, 73.4% stated that they regularly performed PCAS (hypnotics: 84.7%; analgesics: 71.1%; relaxants: 29.7%). Indications were pressing against the respirator (88.3%), analgesia (74.1%), synchronization to respirator (59.5%), and change of airway device (52.6%). Reasons for not performing PCAS (26.6%) included unconscious patients (73.7%); concern about hypotension (31.6%), re-arrest (26.3%), and worsening neurological assessment (22.5%). Complications of PCAS were observed by 19.3% of participants (acute hypotension [74.6%]); (re-arrest [32.4%]). In addition to baseline monitoring, PRC included 12-lead-electrocardiogram (96.6%); capnography (91.6%); catecholamine therapy (77.6%); focused echocardiography (20.6%), lung ultrasound (12.0%) and abdominal ultrasound (5.6%); induction of hypothermia (13.6%) and blood gas analysis (7.4%). An etCO2 of 35–45 mm Hg was targeted by 40.6%, while 9.0% of participants targeted an SpO2 of 94–98% and 19.2% of participants targeted a systolic blood pressure of ≥ 100 mm Hg. Conclusions Prehospital PRC in Germany is heterogeneous and deviations from its target parameters are frequent. PCAS is frequent and associated with relevant complications. The development of preclinical care algorithms for PCAS and PRC within preclinical care seems urgently needed

Effects of COVID-19 on a mature citizen first responder system in the German district of Gutersloh: an observational study

Jansen G, Brüntje D, Deicke M, et al. Effects of COVID-19 on a mature citizen first responder system in the German district of Gutersloh: an observational study. Minerva Anestesiologica . 2024.BACKGROUND: The aim of this study was to examine the impact of COVID-19 on the response rate of community-first-responders (CFR) and other out-of-hospital-cardiac-arrest (OHCA) outcomes using the smartphone-first-responder-system (SFRS) "Mobile Retter."; METHODS: All adult non-traumatic OHCA in the district of Gutersloh between 01.01.2018-31.12.2021 were included. Periods of interest were 1) prior to the first COVID-19-lockdown; to 2) both lockdowns; and 3) the time in between, as well as after the COVID-19-lockdowns (pre-COVID-19, COVID-19-lockdown and COVID-19-pandemic respectively). The primary outcome was the CFR response rate defined as proportion of CFR alerts that were accepted by a CFR and in which at least one CFR arrived on scene of the emergency out of all CFR alerts. Secondary outcomes included the rate of CFR alerts, defined as proportion of OHCA to which CFR were summoned by the emergency medical dispatcher, as well as the rate of return-of-spontaneous-circulation (ROSC) and rate of survival until hospital discharge. We also examined the incidence COVID-19-infection of CFR in context of the SFRS.; RESULTS: A total of 1064 OHCA-patients (mean age: 71.4±14.5 years; female: 33.8%) were included in the study (Pre-COVID-19: 539; COVID-19-lockdown: 109; COVID-19-pandemic: 416). The response rate was 64.0% (pre-COVID-19: 58.7%; COVID-19-lockdown: 63.5%; COVID-19-pandemic: 71.8%, P=0.002 vs. pre-COVID-19). The alert rate was 52.7% (pre-COVID-19: 56.2%; COVID-19-lockdown: 47.7%, P=0.04 vs. Pre-COVID-19; COVID-19-Pandemic: 49.5%, P=0.02 vs. pre-COVID-19). The ROSC-rate was 40.4% (pre-COVID-19: 41.0%; COVID-19-lockdown: 33.9%; COVID-19-pandemic: 41.4%) and hospital discharge rate 31.2% (Pre-COVID-19: 33.0%; COVID-19-lockdown: 36.8%; COVID-19-pandemic: 28.7%). The use of CFR was associated with favorable effects in terms of hospital admission (odds ratio [OR]: 0.654 (CI95: 0.444-0.963), P=0.03), hospital discharge (OR: 2.343 (CI95: 1.002-5.475), P=0.04). None of the CFR became infected with COVID-19.; CONCLUSIONS: "Mobile-Retter" was associated with high response rates, improved outcome in OHCA patients and no COVID-19-infections of CFR during the COVID-19-pandemic and -lockdowns