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H-R Arntz

Publications and source records attributed to H-R Arntz.

7 recordsLinked to original sources
PubMed2005

[Automated external defibrillators: perspectives and outlook].

In Germany about 80.000 patients die of sudden cardiac death each year with enormous human, social and economic consequences. Most cases of sudden cardiac death are caused by ischemia-triggered ventricular fibrillation. A precondition for survival of the victims is an optimally and fast reacting "chain of survival". One of the central links of this chain is timely defibrillation, which is the only effective therapy for treatment of ventricular fibrillation. Automated external defibrillators proved to be a major step forward in improvement of resuscitation results. It has been convincingly demonstrated, that these devices not only are safe and efficacious in the hands of rescue personnel of different qualification degrees but also in the hands of minimally trained "first responders" and even in the hands of untrained lay people. This story of success was paralleled by the development of a new generation of biphasic defibrillators, which have a superior efficacy, are lightweight and are even cheaper than conventional devices. It must however kept in mind, that progress offered by these new opportunities will only translate in better resuscitation results, when programmes are thoroughly planned, will stay under continuous quality control with regard to performance of devices and rescuers and if new knowledge in resuscitation is adequately incorporated in action protocols.

Cardiopulmonary Resuscitation↗
PubMed2004

[Thrombolysis in ST-elevation myocardial infarction. Current role in the light of recent studies].

As acute percutaneous interventions are only performed in about 20% of patients in Germany, thrombolysis will continue to play an essential role in the treatment of ST-elevation infarction. There is no real alternative to thrombolysis in hospitals without catheter facilities or with long transport times, especially for patients with a short duration of symptoms. Prehospital thrombolysis is widely underused despite its proven efficacy and safety. This is especially the case with respect to mortality of patients with symptoms <3 h, where thrombolysis seems to be at least as effective as or even superior to percutaneous coronary intervention (PCI) with respect to mortality (most probably by avoiding cardiogenic shock). "Facilitated PCI", i.e. thrombolysis +/-Gp IIb/IIIa receptor blocker and consecutive routine PCI is attractive and may be an option for the future. However, the logistic burden and problems of availability of EMS have not yet been investigated. Also, the principal value of "rescue PCI"still needs to be clarified. Moreover, defining simple clinical parameters which help to detect ineffective thrombolysis as well as time windows for detection and consecutive rescue intervention are urgent tasks for the near future. In order to guarantee an optimized and individualized therapy for the patient with acute myocardial infarction, peripheral hospitals, intervention centres and emergency medical services should set up networks, which consider the local resources, time lines and the specific conditions of the patient.

Acute Disease↗
PubMed2004

Perspectives and new approaches for improving cardiopulmonary resuscitation in adults beyond current guidelines.

Setting clear priorities for the sequence and importance of actions during cardiopulmonary resuscitation (CPR) is of utmost importance for future guidelines. Unless performed under the rare condition of hypoxic arrest, combined compression and ventilation is usually not necessary in one-rescuer resuscitation of adults. After notifying the emergency medical services (EMS), precordial compression at a rate of 100/min is just as effective or may even be preferable in the majority of cases caused by arrhythmic arrest. Considering the pathophysiological and experimental evidence, chest compression has proven to be more important, even in multi-rescuer settings, than resuscitation ventilation with its problems and risks. International recommendations for compression without respiration for rescuers unwilling to perform resuscitation ventilation or for so-called telephone CPR were not included in the guidelines of the European Resuscitation Council (ERC) probably for reasons of brevity and simplification. However, training for basic cardiopulmonary resuscitation of adults with cardiac arrest should also stress the importance of chest compression over ventilation. Moreover, current studies controversially discuss the optimal time point of defibrillation after collapse. These findings point to the enormous demand for research in the field of cardiopulmonary resuscitation.

Adult↗
PubMed2004

[Recommendations for secondary prevention after myocardial infarction].

The new ESC guidelines for secondary prevention after STEMI recommend acetylsalicylic acid, betablockers, ACE inhibitors, statins and as a new therapeutic option 1 g n-3-fatty acids. They also advocate strict control of elevated blood pressure and plasma glucose level. To stop smoking remains obligatory, supplemented by the advice to adhere to a mediterranean diet. The clinical value of using 1 g n-3-fatty acids was shown in the GISSI-P trial and seem to reduce especially arrhythmic events. Considering the number needed to treat for the different pharmacologic therapies, betablockers and ACE inhibitors are essentials if not contraindicated, n-3-fatty acids and statins show each comparable efficacy while acetylsalicylic acid still provides a good cost/benefit relation due to its low price.

Cardiovascular Agents↗