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Introduction
Publications
Publications (527)
This study compared the treatment outcomes of acute exacerbation of COPD (AECOPD) at an academic tertiary care emergency department before and during the COVID-19 pandemic. Analyzing data from 976 patients, our study showed a significant surge in overall respiratory therapy interventions amidst the noticeable decline in the total number of AECOPD c...
Zusammenfassung
Akute Stoffwechselentgleisungen können für Erwachsene in Abhängigkeit von ihrem Ausmaß lebensbedrohlich sein. Dementsprechend sind eine rasche umfassende Diagnostik und Therapie sowie eine enge Überwachung der Vitalparameter und Laborbefunde erforderlich. Bei der Therapie, die sich bei der ketoazidotischen (DKA) und hyperglykämisch-...
Importance
Whether the simultaneous intravenous administration of potassium and magnesium is associated with the probability of spontaneous conversion to sinus rhythm (SCV) in the acute treatment of atrial fibrillation (AF) and atrial flutter (AFL) is unknown.
Objective
To assess potassium and magnesium administration and SCV probability in AF and...
AimsTo evaluate the performance of the ABC (Age, Biomarkers, Clinical history) and CHA2DS2-VASc stroke scores under real-world conditions in an emergency setting.Methods and ResultsThe performance of the biomarker-based ABC-stroke score and the clinical variable-based CHA2DS2-VASc score for stroke risk assessment were prospectively evaluated in a c...
Patients with recurrence of atrial tachyarrhythmia after catheter ablation for atrial fibrillation or atrial flutter constitute a rapidly growing cohort, but study-driven treatment recommendations are lacking. The present study aimed to compare the cardioversion success of ibutilide and amiodarone in patients with post-ablation atrial tachyarrhythm...
QT interval prolongation and ventricular tachyarrhythmia are potential adverse effects of antidepressant (AD) and antipsychotic- (AP) agents, especially when overdosed. Since AD and AP agents are often prescribed to patients suffering from suicidal intentions, it is essential to estimate these risks in the context of intoxications. This retrospecti...
Background and Aims
Skeletal muscle area (SMA) in the computed tomography (CT) at the third lumbar vertebra (L3) level is a proxy for whole-body muscle mass but is only performed for clinical reasons. Ultrasound is a promising tool to determine muscle mass at the bedside. It is still unclear how well ultrasound and which ultrasound measuring points...
Background
Overcrowding decreases quality of care. Triage and patient administration are possible bottlenecks. We aimed to identify factors influencing door-to-triage- and triage-to-patient administration-time in a prospective observational study at a tertiary care center with 70,000 patients per year.
Methods
Measurement of aforementioned times a...
Background
We investigated the influence of population-wide COVID-19 lockdown measures implemented on 16, March 2020 on routine and emergency care of cancer outpatients at a tertiary care cancer centre in Vienna, Austria.
Methods
We compared the number/visits of cancer outpatients receiving oncological therapies at the oncologic day clinic (DC) an...
This article is about of two cases of successful cardiopulmonary resuscitation (CPR) and using therapeutic hypothermia as a important part of treatment of post-resuscitation disease. Current evidence supports that induction of therapeutic hypothermia in selected patients after cardiac arrest can improve neurological outcome. It is hoped that by sum...
Rationale:
The immunologic syndrome induced by severe acute coronavirus disease 2019 (COVID-19) is yet not fully understood. Typical patterns of clinical and laboratory features match secondary hemophagocytic lymphohistiocytosis (sHLH). However, the optimal approach to COVID-19 patients testing positive for sHLH is still unclear.
Patient concerns...
Objective
Early diagnosis or rule‐out of acute coronary syndrome (ACS) is a key competence of emergency medicine. Changes of the NSTE‐ACS guidelines of the European Society of Cardiology (ESC) in 2015 and 2020 both warranted a henceforth more conservative approach regarding high‐sensitivity troponin t (hsTnt) testing.
We aimed to assess the impact...
Background: National authorities have introduced measures as lockdowns against spreading of COVID-19 and documented incidences of multiple non-COVID-19 diseases have dropped. Yet, data on workload dynamics concerning atrial fibrillation and electrical cardioversion whilst a national lockdown are scarce and may assist in future planning.
Methods: Do...
Background : Patients with high- and low-voltage electrical injuries differ in their clinical presentation from minor symptoms to life-threatening conditions. For an adequate diagnosis and treatment strategy a multidisciplinary team is often needed, due to the heterogeneity of the clinical presentation. To minimize costs and medical resources, espe...
Emergency medicine and intensive care medicine have many similarities. In this review, we will first discuss the terminology of emergency medicine in a hospital in terms of a uniform designation as a department for emergency medicine or emergency department. Emergency medicine and intensive care medicine are a location-independent concept of patien...
Background: The COVID-19 pandemic has resulted in the suspension of the entire teaching program at the Medical University of Vienna till the end of the summer semester. As the department that is responsible for emergency medicine teaching, we adapted the program to continue the courses and maintain the learning progress. Our objective is to evaluat...
Background and importance
Emergency department (ED) admissions have been rising over the last decades, especially in countries without any effective gate-keeping functions. Integration of walk-in clinics into the hospital might reduce ED-visits. Over a longer period, however, the additional service of a walk-in clinic might attract even more patien...
Background: The COVID-19 pandemic resulted in suspension of the whole teaching program at the Medical University of Vienna until the end of summer semester. Therefore, a substantial waste of learning time threatens. As the responsible department for emergency medicine teaching, we adapted our program to continue with our courses and maintain the le...
Erratum zu: Wien Klin Wochenschr 2018 10.1007/s00508-018-1423-z Die Originalversion des Beitrags enthielt leider einen Fehler in Tab. 3. In der publizierten Version war in der 1. Spalte PO4 im Plasma mit 0 und Mg mit 1,25 angegeben, wobei auch Kalzium auf einen Wert im mittleren …
Aims:
Rapid restoration of sinus rhythm is an integral part of the management of recent-onset atrial fibrillation. We aimed to assess safety and efficacy of vernakalant, a multi-channel blocking agent, in combination with external electrical cardioversion.
Methods:
This prospective cohort study comprised 230 patients (female 35%; median age 50 I...
6609
Background: Oncologic patients frequently seek out the ED as first contact point. Besides the rare classic oncologic emergencies other causes are supposed to be more frequent. However, little is known about reasons of patients with active malignancies to consult the ED. Methods: Retrospective data regarding emergency visits of patients with a...
Zusammenfassung
Akute Stoffwechselentgleisungen können für Erwachsene in Abhängigkeit von ihrem Ausmaß lebensbedrohlich sein. Dementsprechend sind eine rasche umfassende Diagnostik und Therapie sowie eine enge Überwachung der Vitalparameter und Laborbefunde erforderlich. Bei der Therapie, die sich bei der ketoazidotischen (DKA) und hyperglykämisch-...
Objective:
The aim of this single-centre study was the comparative analysis of the GeneXpert (Cepheid Inc.) and the LIAT (Roche) system for the rapid polymerase chain reaction (PCR)-based detection of influenza A (IA) and influenza B (IB) viruses.
Patients and methods:
During the 2017-2018 flu season, 651 prospectively collected samples (throat...
Objectives
To assess the predictive value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TnT) serum levels for mid-term mortality in patients presenting with symptomatic atrial fibrillation (AF) to an emergency department.
Methods
Non-interventional cohort/follow-up study, including consecutive patients p...
S U M M A R Y Atrial fibrillation (AF) is a chaotic, irregular atrial rhythm at 300-600 bpm. The AV node conducts the impulse intermittently, causing the irregular ventricular rate. The main risk is of embolism (stroke), which is preventable by anticoagulation. The current estimate of the AF prevalence in the developed world is approximately 1.5-2%...
Carbon monoxide (CO) is a leading cause of morbidity and mortality. Treatment focuses on the rapid elimination of CO and management of hypoxia. Oxygen is the cornerstone of therapy, and usually applied via a reservoir face mask. Hyperbaric oxygen therapy eliminates CO faster, but requires extensive equipment and expertise. Non-invasive continuous p...
Background:
Educational aspects in the training of advanced life support (ALS) represent a key role in critical care management of patients with out-of-hospital cardiac arrest (OHCA) and received special attention in guidelines of various international societies. While a positive association of feedback on ALS performance in training conditions is...
Objective:
To investigate the feasibility of a refined aortic flush catheter and pump system to induce emergency preservation and resuscitation before extracorporeal cardiopulmonary resuscitation in a normovolemic cardiac arrest swine model simulating near real size/weight conditions of adults.
Methods:
In this feasibility study, 8 female Large...
Introduction:
There are several clinical settings and patient conditions especially in intensive care units, emergency departments, and operating theaters, where the coagulation status of a patient must be known immediately and point-of-care (POC) systems are beneficial due to low time to result.
Methods:
This noninterventional, single-blinded,...
Aim:
Cardiac arrest centers have been associated with improved outcome for patients after cardiac arrest. Aim of this study was to investigate the effect on outcome depending on admission to high-, medium - or low volume centers.
Methods:
Analysis from a prospective, multicenter registry for out of hospital cardiac arrest patients treated by the...
Cerebral metabolic alterations during cardiac arrest, cardiopulmonary resuscitation (CPR) and extracorporeal cardiopulmonary life support (ECLS) are poorly explored. Markers are needed for a more personalized resuscitation and post—resuscitation care. Aim of this study was to investigate early metabolic changes in the hippocampal CA1 region during...
Correct position of the MD probe.
Puncture channel in the hippocampal CA 1 region with mild bleeding; arrows: pyramidal layer of the hippocampus; H&E staining, 200x magnification.
(PDF)
Setup sketch of the ECLS experiment.
(PDF)
Setup sketch of the CPR experiment.
(PDF)
Reactive brain lesions after implantation of the guiding cannula.
Mild mononuclear infiltration of the meninges, edema and gliosis in the cerebral cortex; H&E staining, 100x magnification.
(PDF)
Detailed protocol for post operative animal management.
(PDF)
Background: The endotracheal tube (ETT) is considered the
gold standard in emergency airway management, although
supraglottic airway devices, especially the laryngeal tube
(LT), have recently gained in importance. Although regarded
as an emergency device in case of failure of endotracheal
intubation in most systems, we investigated the dynamics
of...
Aims
Ibutilide is a rapid-acting antiarrhythmic drug with worldwide use for conversion of recent-onset atrial fibrillation. Vernakalant, approved in the EU in 2010, is likewise used intravenously, with proven efficacy and safety compared with placebo and amiodarone in randomized clinical trials. The aim of our study was to compare the time to conve...
Background:
While contributors to system delay in ST-elevation myocardial infarction (STEMI) are well described, predictors of patient-related delays are less clear. The aim of this study was to identify predictors that cause delayed diagnosis of STEMI in a metropolitan system of care (VIENNA STEMI network) and to investigate a possible associatio...
Ischaemic mitral regurgitation (IMR) is a common complication of coronary artery disease with serious morbidity and mortality. Acute IMR due to rupture of papillary muscle, mitral leaflets or chordae in acute myocardial infarction represents a life-threatening and eminently correctable complication with poor prognosis. Chronic IMR occurs as a late...
INTRODUCTION: Pneumothorax is abnormal collection of air in the pleural space occuring
when there is discontinuity between visceral and parietal pleura. When communication between bronchi,
alveololi and pleural cavity occurs, atsmopheric and intrapleural pressure are being equalized, which lead
to decrease in lung compliance thus causing collapsed...
Aim:
Cardiac arrest (CA) is still associated with high mortality and morbidity. Data on the changes in management and outcomes over a long period of time are limited. Using data from a single emergency department (ED), we assessed changes over two decades.
Methods:
In this single-center observational study, we prospectively included 4133 patient...
Background:
In clinical practice, monitoring of the efficacy of resuscitation can be challenging. The prediction of cerebral and overall outcome in particular is an unmet medical need. Microdialysis is a minimally invasive technique for the continuous determination of metabolic parameters in vivo. Using this technique, we set out to establish a mo...
Introduction: Ibutilide is a rapid-acting antiarrhythmic drug with worldwide use for conversion of recent-onset atrial fibrillation. Vernakalant is a novel drug, which is likewise used intravenously, with proven effectiveness and safety compared to placebo and amiodarone in randomized clinical trials.
Hypothesis: We hypothesized that the time to si...
More than 20 years ago we reported an analysis of a case series of elderly critically ill patients with acute kidney injury (AKI)-then termed acute renal failure. At that time, AKI was regarded as a "simple" complication, but has since undergone a fundamental change and actually has become one of the central syndromes in the critically ill patient....
Background and aim:
Systems of care to treat acute ST-elevation myocardial infarction (STEMI) have been developed world wide in the past decade. Their effectiveness can only be proven by including and analyzing outcome data of consecutive patients in registries, which is not the case in the majority of STEMI networks. This study investigates 1-yea...
Ein 63-jähriger Mann bricht beim Tennisspielen zusammen und bleibt reglos liegen. Die anwesenden Personen können keine Atmung
feststellen und beginnen mit der Herz-Lungen-Wiederbelebung. Die sofort alarmierte Rettung trifft 12 min nach dem Kollaps
ein und setzt die Reanimationsmaßnahmen fort. Der EKG-Monitor zeigt Kammerflimmern, der Patient wird s...
In CPR, sufficient compression depth is essential. The American Heart Association ("at least 5cm", AHA-R) and the European Resuscitation Council ("at least 5cm, but not to exceed 6cm", ERC-R) recommendations differ, and both are hardly achieved. This study aims to investigate the effects of differing target depth instructions on compression depth p...
Myocarditis is an inflammatory disease of the myocardium. The dia gnosis is based on clinical criteria, ECG findings, biomarkers and cardiac imaging, and can be confirmed by histological, immunological and immunohistochemical analysis. The aetiology of myocarditis is heterogeneous and remains undetermined in about 50% of cases. However, a large var...
Deficits in cognitive function are a well-known dysfunction in survivors of cardiac arrest. However, data concerning memory function in this neurological vulnerable patient collective remain scarce and inconclusive. Therefore, we aimed to assess multiple aspects of retrospective and prospective memory performance in patients after cardiac arrest.Me...
Background: Based on demographic changes in the western world, the number of patients with cardiac arrest due to a cardiovascular event is continuously rising. A large variety of factors impacting on favorable neurological outcome (CPC 1-2) and the 6-month survival, are well established. The question whether the knowledge about these predictive fac...
Aim
Improvement in predicting survival after out-of-hospital cardiac arrest is of major medical, scientific and socioeconomic interest. The current study aimed at developing an accurate outcome-prediction tool for patients following out-of-hospital cardiac arrests.
Methods
This retrospective cohort study was based on a cardiac arrest registry. Fro...
Rotational thrombelastometry may be an adjuvant tool to guide decisions in non-traumatic hyperfibrinolytic bleedings. The efficacy of tranexamic acid to restore clotting in a given patient may be tested thrombelastometrically prior to its administration. APTT could be a marker of the severity of hypofibrinogenemia in hyperfibrinolytic type of DIC
Background
Accidental hypothermic cardiac arrest is associated with unfortunate prognosis and large studies are rare. We therefore have performed an outcome analysis in patients that were admitted to Vienna University Hospital with the diagnosis of accidental hypothermic cardiac arrest.
Methods
This study employed a retrospective outcome analysis...
Carbon monoxide (CO) is regarded as a leading cause of morbidity and mortality. It endangers not only patients, but also health care professionals, especially emergency medical services (EMS) personnel because CO exposure is often unknown at the time EMS is called.
Our objective was to report a case of unrecognized CO exposure during the treatment...
Kurzfassung: Einleitung: Die Universitätsklinik für Notfallmedizin (NFM) ist Teil des ST-Eleva-tion-Myocardial-Infarction-(STEMI-) Netzwer-kes Wien und ist an Wochenenden primärer An-laufpunkt für Patienten mit Verdacht auf STEMI. In dieser Zeit ist das Herzkatheter-Team der Kli-nischen Abteilung für Kardiologie der Universi-tätsklinik für Innere M...
Background: The Emergency Department (ED) is part of the ST-Elevation Myocardial Infarction (STEMI) Network, Vienna and primary venue for patients with suspected STEMI on weekends. During these times the cath-lab-team of the Department of Cardiology is on duty day and night. Methods: We present the data for the year 2011 from our Myocardial Infarct...
Hintergrund
In den letzten Jahren etablierten sich im deutschsprachigen Raum immer mehr interdisziplinäre Notfallaufnahmen (Notfallabteilungen) mit eigenständigen Organisationsstrukturen als Anlaufstelle für alle Patienten mit akut aufgetretenen medizinischen Problemen. Ziel dieses Beitrags ist es, die Notwendigkeit intensivmedizinischer Kompetenz...
Notfälle im Kreißsaal sind eher seltene Ereignisse, bedrohen aber zumeist zwei oder mehrere Leben gleichzeitig. Nicht immer sind sie vorhersehbar oder kündigen sich langfristig an. „Seltenes“ muss nachweislich geübt werden, am besten in Teamtrainings. Dieses Training ist nicht nur in der Luftfahrt Pflicht, sondern auch für Katastropheneinsatzteams...
Ein 63-jähriger Mann bricht beim Tennisspielen zusammen und bleibt reglos liegen. Die anwesenden Personen können keine Atmung feststellen. Eine Person beginnt sofort mit der Herz-Lungen-Wiederbelebung, während eine andere die Rettung ruft. Ein sich in der Nähe befindender AED wird geholt. Die Rettung trifft 9 min nach dem Kollaps ein und setzt die...
Severe hypokalemia is a potentially life-threatening disorder and is associated with variable degrees of skeletal muscle weakness, even to the point of paralysis. On rare occasions, diaphragmatic paralysis from hypokalemia can lead to respiratory arrest. There may also be decreased motility of smooth muscle, manifesting with ileus or urinary retent...
An emergency department providing critical care will have an effect on outcome and intensive-care-units' resources by avoiding unnecessary or futile intensive-care admissions and thereby save hospital expenses. The study focussed on this result.
The study employed a retrospective analysis of prospectively collected data of out-of-hospital cardiac a...
Accurate and timely diagnosis of carbon monoxide (CO) poisoning is difficult because of nonspecific symptoms. Multiwave pulse oximetry might facilitate the screening for occult poisoning by noninvasive measurement of carboxyhemoglobin (COHb), but its reliability is still unknown. We assess bias and precision of COHb oximetry compared with the crite...
To The Editor:
With interest we have read the article by Kitamura and colleagues about bystander initiated rescue breathing for out-of-hospital cardiac arrest of noncardiac origin.1 The authors included a large number of patients from a population based registry and concluded that rescue breathing has an incremental benefit for out-of-hospital car...
The induction of deep cerebral hypothermia via ice-cold saline aortic flush during prolonged ventricular fibrillation cardiac arrest, followed by hypothermic stasis and delayed resuscitation (emergency preservation and resuscitation), improved neurologic outcome after cardiac arrest in pigs, as compared to conventional resuscitation. We hypothesize...
See also Levi M. Disseminated intravascular coagulation or extended intravascular coagulation in massive pulmonary embolism. This issue, pp 1475–6; Leitner JM, Jilma B, Spiel AO, Sterz F, Laggner AN, Janata KM. Massive pulmonary embolism leading to cardiac arrest is associated with consumptive coagulopathy presenting as disseminated intravascular c...
In mass gatherings, adequate medical care is a major challenge for the emergency medical system. The numbers of patients treated in the field (PPTT, patients per ten thousand participants) and of patients transported to hospitals for further diagnosis or treatment (TPTT, transports per ten thousand participants) may be calculated to estimate the wo...
A consumptive coagulopathy resembling disseminated intravascular coagulation (DIC) has been seen in patients with massive pulmonary embolism (PE). We hypothesized that a DIC-like condition is relevant in patients whose pulmonary embolism leads to cardiopulmonary arrest and cardiopulmonary resuscitation (CPR).
This hypothesis was tested by the use o...
Das komplette Basiswissen zur Notfallmedizin, Anästhesie und Intensivmedizin wird übersichtlich und praxisrelevant dargestellt. Innovativ ist der fallbezogene und interdisziplinäre Zugang, der sich an das neue Curriculum der Medizin anlehnt. Zudem wird der Lehrstoff übersichtlich gegliedert und didaktisch aufbereitet. Zahlreiche Abbildungen und ans...
A 54-year-old woman was admitted to the emergency department with suspected diabetic ketoacidosis (DKA), diagnosed by the emergency doctor. Immediately after shifting the patient to a hospital bed she suffered a cardiac arrest, showing pulseless electric activity (PEA) on the cardiac monitor. A critical analysis of the patient’s history and blood g...
Carbon monoxide (CO) is known as a leading cause of unintentional poisoning death in many countries. Diagnosis is usually made by measuring carboxyhemoglobin (COHb), but due to the non-specific symptoms, the crucial step is considering CO poisoning. A possible solution might be screening emergency department (ED) patients. A cutaneous sensor that m...
We aimed to determine the prognostic value of troponin T (TNT) for in-hospital and 1-yr mortality in a large sample of patients with pulmonary embolism (PE). Patients presenting at the emergency department of a tertiary care centre from January 1998 to December 2006 with PE were included. A blood sample was taken at the time of presentation. To det...
Notaufnahmen haben die Aufgabe der primären Stabilisierung und der Initialdiagnostik, die für eine optimale Weiterversorgung
der Patienten unabdingbare Voraussetzung ist. Damit entwickeln sich die Notaufnahmen von einem Ort, der primär der Verteilung
der Patienten in die verschiedenen Fachabteilungen diente, zu einer gut definierten Funktionseinhei...
To determine whether during the initial phase of head and neck cooling, jugular bulb temperature (Tjb; which may reflect brain temperature) is lower than esophageal temperature (Tes).
To compare Tes and Tjb, patients received head or head and neck cooling after cardiac arrest.
The first series with head cooling (n = 5; mean age 54 with a range of 4...
Application of mild hypothermia (32-33 degrees C) has been shown to improve neurological outcome in patients with cardiac arrest. However, hypothermia affects hemostasis, and even mild hypothermia is associated with bleeding and increased transfusion requirements in surgery patients. On the other hand, crystalloid hemodilution has been shown to ind...
Es wird der Fall einer 69-jährigen Patientin vorgestellt, die wegen seit 5 Tagen bestehender Brustschmerzen und Atemnot hospitalisiert
wurde. Bei Aufnahme zeigte die Patientin die klinischen Zeichen eines kardialen Vorwärts- und Rückwärtsversagens als Folge
einer akuten Herzbeuteltamponade. Da das EKG nur unspezifische Veränderungen zeigte und der...
Purpose of the stud y: Early out-of-hospital induction of mild hypothermia after cardiac arrest needs an easy to use and accurate core temperature monitoring, which might be achievable with tracheal temperature measurement. The aim of the study was to evaluate which tracheal temperature site (Ttra) reflects best pulmonary artery temperature (Tpa) d...
