According to scientific publications focusing on emergency medicine and published in international journals in the past few months, new and clinically important results can be identified. In patients with severe
head trauma (SHT), application of
hypertonic solutions is possible; long term outcome, however, is not improved by this measure. Prehospital capnometry is important, because otherwise up to 40 % of all mechanically ventilated patients are hypoventilated. In a study in 200 patients with prehospital
cardiac arrest and
ventricular fibrillation as initial cardiac rhythm, subgroup analysis (alarm-response time > 5 min) showed an increase in survival rate (14 % vs. 2 %), if defibrillation was proceeded by 3 min of conventional
cardiopulmonary resuscitation (
CPR) for reperfusion. If ACD ("active compression
decompression")-
CPR is combined with a specific ventilatory valve ("inspiratory impedance threshold device", ITD) which does not allow passive inspiration, survival rate after
cardiac arrest is increased for up to 24 h. Such a device facilitates an increase in venous return to the heart during
decompression of the thorax. High-dose adrenalin for intrahospital
CPR in children is not associated with better survival but with worse outcome. Comparison of an emergency medical service (EMS) system from U.K. with paramedics and a physician-staffed German EMS system demonstrated that survival rate following prehospital
cardiac arrest is markedly increased with doctors on board. The European multicentre trial comparing
vasopressin vs. adrenalin as first vasopressor during
CPR in 1219 patients did not reveal any differences between both groups. In subgroup analyses of patients with asystoly and prolonged
CPR,
vasopressin was superior without being associated with a benefit on neurological outcome. Further subgroup analyses revealed beneficial effects of
amiodarone and thrombolysis during
CPR. Thrombolysis during
CPR apears to be associated with an increased rate of haemodynamic stabilisation without increased risk of
bleeding complications. In a very clear advisory statement, the "International Liaison Committee on
Resuscitation" (ILCOR) has recommended mild
therapeutic hypothermia (i. e., cooling of
cardiac arrest victims to 32 - 34 degrees C central body temperature for 12 - 24 h following
cardiac arrest of cardiac etiology) not only for unconciuous patients with
ventricular fibrillation as initial prehospital rhythm, but also for all other adult patients (other rhythms, intrahospital
CPR) following
cardiac arrest. In randomised controlled clinical trials, this
therapy has markedly improved survival rate and neurological outcome. Such therapeutic cooling can be initiated nearly everywhere and with simple methods - like the infusion of
ice-cold cristalloid solutions.