PubMed Health⌕ Search

Biomedical subjects

Klemens Köhler

Publications and source records attributed to Klemens Köhler.

4 recordsLinked to original sources
PubMed2006

Quality of cardiopulmonary resuscitation among highly trained staff in an emergency department setting.

BACKGROUND: Recent reports have highlighted the poor standard of cardiopulmonary resuscitation (CPR) achieved by health care professionals in diverse situations. We explored what can be achieved in an emergency department by highly trained permanent staff. METHODS: In a prospective observational study conducted from June 1, 2002, to August 31, 2005, 80 of 213 patients requiring CPR and admitted to the emergency department of a tertiary care hospital were eligible for study participation. Owing to several logistic problems with CPR, 133 patients could not be studied. The CPR team consisted of emergency- and critical care-trained physicians with more than 10 years of acute care experience, most of whom were instructors of European Resuscitation Council courses in basic and advanced life support. A specially designed defibrillator was used to assess the quality of CPR. RESULTS: For 80 patients, 95 data sets were available for analysis, yielding a total of 1065 minutes of cardiac arrest time. Chest compressions were performed at a rate of 114 (95% confidence interval [CI], 112-116) per minute, resulting in a mean of 96 (95% CI, 93-99) delivered chest compressions per minute. We further observed a mean hands-off ratio of 12.7% (95% CI, 12.3%-13.1%), and the hands-off ratio was linearly associated with the duration of CPR (R(2) = 0.95; mean, 4.3% increments per 5-10 minutes; P<.001). Patients were hyperventilated with a median of 18 (interquartile range, 14-24) ventilations per minute. CONCLUSIONS: Highly trained professionals in an emergency department can achieve appropriate chest compression rates during CPR with a low hands-off ratio. Increased attention must be paid in all situations to the avoidance of hyperventilation.

Aged↗
PubMed2006

Thoracic impedance changes measured via defibrillator pads can monitor ventilation in critically ill patients and during cardiopulmonary resuscitation.

OBJECTIVE: Monitoring of ventilation performance during cardiopulmonary resuscitation would be desirable to improve the quality of cardiopulmonary resuscitation. To investigate the potential for measuring ventilation rate and inspiration time, we calculated the correlation in waveform between transthoracic impedance measured via defibrillator pads and tidal volume given by a ventilator. DESIGN: Clinical study. SETTING: Emergency department of a tertiary care university hospital. PATIENTS: A convenience sample of mechanical ventilated patients (n = 32), cardiac arrest patients (n = 20), and patients after restoration of spontaneous circulation (n = 31) older than 18 were eligible. INTERVENTIONS: The Heartstart 4000SP defibrillator (Laerdal Medical Cooperation, Stavanger, Norway) with additional capabilities of recording thoracic impedance changes was used. MEASUREMENTS AND MAIN RESULTS: The relationship between impedance change and tidal volume (impedance coefficient) was calculated. The mean (sd) correlations between the impedance waveform and the tidal volume waveform in the patient groups studied were .971 (.027), .969 (.032), and .967 (.035), respectively. The mean (sd) impedance coefficient for all patients in the study was .00194 (.0078) Omega/mL, and the mean (sd) specific (weight-corrected) impedance coefficient was .152 (.048) Omega/kg/mL. The measured thorax impedance change for different tidal volumes (400-1000 mL) was approximately linear. CONCLUSIONS: The impedance sensor of a defibrillator is accurate in identifying tidal volumes, when chest compressions are interrupted. This also allows quantifying ventilation rates and inspiration times. However this technology, at its present state, provides only limited practical means for exact tidal volume estimation.

Adult↗
PubMed2006

Gender modifies the influence of age on outcome after successfully resuscitated cardiac arrest: a retrospective cohort study.

Age is an important risk factor for mortality and unfavorable outcome after successfully resuscitated cardiac arrest. Other risk factors may interact with this relationship. We conducted the current study to quantify the influence of age on mortality and unfavorable neurologic outcome of patients surviving out-of-hospital cardiac arrest, and to determine the role of other confounding variables. This study was based on a cardiac arrest registry comprising all patients with witnessed out-of-hospital cardiac arrest of cardiac origin after successful resuscitation admitted to a department of emergency medicine between September 1991 and December 2004. We assessed the association between age and mortality and the degree of neurologic impairment, adjusting for multiple risk factors. We tested for interaction between age and all other risk factors with outcome. With each year of age the adjusted odds ratio for in-hospital death increased by 1.05 (95% confidence interval [CI], 1.04-1.07), and the adjusted odds ratio for an unfavorable neurologic outcome increased by 1.04 (95% CI, 1.03-1.06). Interaction between age and sex was present, and the analysis was stratified to sex. For men we found a steep risk increase for death and unfavorable outcome after being resuscitated from cardiac arrest, with the highest risk in the oldest age quartile. For women we observed only a slight risk increase for death and almost no risk increase for unfavorable outcome. Age is a strong independent risk factor for mortality and neurologic impairment after successfully resuscitated cardiac arrest. The risk increase with advancing age is much greater in men than in women. Therefore, in women, the influence of age on prognosis after cardiac arrest may not be very important, while in men it still plays an important role. This should be considered especially when treating successfully resuscitated women and discussing the prognosis with the medical team or the patient's family.

Adult↗