Incidence and challenges of helicopter emergency medical service (HEMS) rescue missions with helicopter hoist operations: analysis of 11,228 daytime and nighttime missions in Switzerland.

Objective: We aimed to investigate the medical characteristics of helicopter hoist operations (HHO) in HEMS missions.

Methods: We designed a retrospective study evaluating all HHO and other human external cargo (HEC) missions performed by Swiss Air-Rescue (Rega) between January 1, 2010, and December 31, 2019.

Results: During the study period, 9,963 (88.

[Changes in number of emergency medical service deployments in an urban area during the first COVID-19 pandemic-related contact restriction phase].

Background: To contain the coronavirus disease (COVID-19) pandemic, public life was reduced through contact restriction measures (referred to as "lockdown" in the further course for reading simplicity), among other things to make health system resources available for the treatment of COVID-19 patients. In parallel, a decrease in emergency patients was observed in the public health system.

Methods: For two 10-week periods before and during the lockdown, ambulance service deployment rates were analysed in 6 ambulance service areas for 6 tracer diagnoses.

[Automatic load-distributing band CPR (AutoPulse™) in prone position, feasible?].

Background: Due to SARS-CoV‑2 respiratory failure, prone positioning of patients with respiratory and hemodynamic instability has become a frequent intervention in intensive care units (ICUs), and even in patients undergoing transfer in an ambulance or helicopter. It has become increasingly important how to perform safe and effective CPR in prone position, achieving both an optimal outcome for the patient and optimal protection of staff from infection.

Materials And Methods: We conducted feasibility tests to assess the effects of CPR with an automatic load-distributing band (AutoPulse™) in prone position and discussed different aspects of mechanical chest compression (mCPR) in prone position.

Efficacy and efficiency of indoor nighttime human external cargo mission simulation in a high-fidelity training Centre.

Background: The human external cargo (HEC) operations conducted by Helicopter Emergency Medical Services (HEMS) rarely take place at night, making it difficult for crew members to attain and maintain the level of expertise needed to perform winch operations in the dark. As EASA requirements for training cannot currently be met, we evaluated whether simulation training could be an option.

Methods: This paper reports on a training concept using indoor simulation for the training of nighttime HEC operations.

Challenges of helicopter mountain rescue missions by human external cargo: need for physicians onsite and comprehensive training.

Background: Human external cargo (HEC) extrication during helicopter rescue missions is commonly used in mountain emergency medical services. Furthermore, longline or winch operations offer the opportunity to deliver professional medical care onsite. As the safety and quality of emergency medical care depends on training and experience, we aimed to investigate characteristics of mountain rescue missions with HEC.

Advanced airway management in hoist and longline operations in mountain HEMS - considerations in austere environments: a narrative review This review is endorsed by the International Commission for Mountain Emergency Medicine (ICAR MEDCOM).

Background: Providing sufficient oxygenation and ventilation is of paramount importance for the survival of emergency patients. Therefore, advanced airway management is one of the core tasks for every rescue team. Endotracheal intubation is the gold standard to secure the airway in the prehospital setting.

Helicopter Emergency Medical Service Simulation Training in the Extreme: Simulation-based Training in a Mountain Weather Chamber.

Mountain rescue operations often confront crews with extreme weather conditions. Extremely cold temperatures make standard treatment sometimes difficult or even impossible. It is well-known that most manual tasks, including those involved in mountain rescue operations, are slowed by extremely cold weather.

Elevated Serum Glial Fibrillary Acidic Protein (GFAP) is Associated with Poor Functional Outcome After Cardiopulmonary Resuscitation.

Background: The neurological prognosis of patients after cardiopulmonary resuscitation (CPR) is difficult to assess. GFAP is an astrocytic intermediate filament protein released into bloodstream in case of cell death. We performed a prospective study aiming to compare the predictive potential of GFAP after resuscitation to the more widely used biomarker neuron-specific enolase (NSE).

Simulation-Based Training in Mountain Helicopter Emergency Medical Service: A Multidisciplinary Team Training Concept.

Objective: Mountain helicopter rescue operations often confront crews with unique challenges in which even minor errors can result in dangerous situations. Simulation training provides a promising tool to train the management of complex multidisciplinary settings, thus reducing the occurrence of fatal errors and increasing the safety for both the patient and the helicopter emergency medical service (HEMS) crew.

Methods: A simulation-based training, dedicated to mountain helicopter emergency medicine service, was developed and executed.

Mechanical chest compressions in an avalanche victim with cardiac arrest: an option for extreme mountain rescue operations.

Mountain rescue operations often present helicopter emergency medical service crews with unique challenges. One of the most challenging problems is the prehospital care of cardiac arrest patients during evacuation and transport. In this paper we outline a case in which we successfully performed a cardiopulmonary resuscitation of an avalanche victim.

Comparison of three anesthetic techniques for off-pump coronary artery bypass grafting: general anesthesia, combined general and high thoracic epidural anesthesia, or high thoracic epidural anesthesia alone.

Objective: This study compared general anesthesia (GA), combined GA plus thoracic epidural anesthesia (TEA), and TEA alone in patients scheduled for off-pump coronary artery bypass grafting.

Design: Prospective, nonrandomized clinical study

Setting: University hospital.

Participants: Ninety consenting patients undergoing beating-heart coronary artery revascularization with comparable coronary status and left ventricular function.

Segmental myocardial wall motion during minimally invasive coronary artery bypass grafting using open and endoscopic surgical techniques.

Current options for minimally invasive surgical treatment of single-vessel coronary artery disease include beating heart procedures without cardiopulmonary bypass (CPB) via mini-thoracotomy (MIDCAB) and totally endoscopic robot-assisted techniques (TECAB) with CPB. Both procedures are associated with potential myocardial stress before revascularization, such as single-lung ventilation (SLV), temporary coronary artery occlusion, cardiac luxation, intrathoracic carbon dioxide insufflation, and extended CPB and operating time. In this echocardiographic study we sought to evaluate the extent of intraoperative segmental wall motion abnormalities (SWMA) during MIDCAB and TECAB surgery and to identify factors affecting SWMA.

Peri-operative complications during percutaneous tracheostomy in obese patients.

The safety of percutaneous tracheostomy in 73 obese patients (body mass index > or = 27.5 kg.m(-2)) in a cohort of 474 adults was studied.

[Transthoracic defibrillation. Physiologic and pathophysiologic principles and their role in the outcome of resuscitation].

As one major link in the chain of survival, early transthoracic (external) cardiac defibrillation is aimed at the termination of ventricular flutter and ventricular fibrillation. Most important to the success of defibrillation is the passage of a defined amount of current through a critical mass of heart muscle. Different transthoracic resistances reduce the effective density of the current within the heart.

[Analysis of ventricular fibrillation signals for the evaluation of defibrillation success in the treatment of ventricular fibrillation].

Objective: Precise detection of ventricular fibrillation (VF), reliable prediction of defibrillation success and adjustment of the discharge waveform to the patient's transthoracic impedance may contribute to a reduction of electricity-associated myocardial injury caused by unnecessary counter shocks. Specifically, asystole thresholds distinguish between VF and asystole, and thus prevent unnecessary defibrillation attempts. We reviewed various studies and manufacturer characteristics regarding the parameters and algorithms for analyzing arrhythmia ECG signals.

Echocardiographic findings in minimally invasive coronary artery bypass grafting: The role of intrathoracic CO2 - insufflation and single lung ventilation.

Background: Current options for surgical treatment of coronary single vessel disease range from beating heart procedure without cardiopulmonary bypass via a mini thoracotomy (MIDCAB) to totally endoscopic robot-assisted techniques (TECAB) with cardiopulmonary bypass. Both procedures are associated with considerable stress even before revascularization such as single lung ventilation, temporary coronary occlusion, Luxatio cordis, intrathoracic CO2 insufflation and extended bypass and operating time. The aim of the this study was to document the extent of intraoperative segmental wall motion abnormalities (SWMA) by echocardiography, and to identify variables affecting SWMA.

Coronary artery bypass grafting via sternotomy in conscious patients.

The application of high thoracic epidural anesthesia (TEA) as an adjunct to general anesthesia is increasingly being used for coronary artery bypass grafting (CABG) with extracorporeal circulation. Recent developments in beating heart techniques rendered the sole use of TEA in conscious patients possible, and have been reported for single-vessel beating heart CABG via lateral thoracotomy. For multi-vessel revascularization, the heart is usually approached via sternotomy; therefore, the sole use of TEA was applied in awake patients who underwent CABG via sternotomy.

PercuTwist: a new single-dilator technique for percutaneous tracheostomy.

PercuTwist is a new technique for percutaneous tracheostomy in that stoma dilation is achieved with a unique screwlike dilating device. We describe the technique itself and our first clinical experiences with PercuTwist.

High thoracic epidural anesthesia for coronary artery bypass grafting using two different surgical approaches in conscious patients.

Recent developments in coronary artery bypass graft surgery (CABG) without cardiopulmonary bypass made the sole use of high thoracic epidural anesthesia (TEA) in conscious patients feasible. Previously, TEA has been reported only for single-vessel CABG via lateral thoracotomy. We investigated the feasibility and complications of sole TEA in 20 patients undergoing beating-heart arterial revascularization via partial lower sternotomy for single-vessel disease (minimally invasive direct coronary artery bypass grafting [MIDCAB] technique; n = 10) or complete median sternotomy for multivessel disease (off-pump coronary artery bypass grafting [OPCAB] technique; n = 10).

[Coronary bypass operation with complete median sternotomy in awake patients with high thoracic peridural anesthesia].

Objective: High thoracic epidural anesthesia (TEA) combined with general anesthesia is increasingly being used for coronary artery bypass grafting (CABG) with extracorporeal circulation. Recent developments in beating heart techniques have rendered the use of TEA alone in conscious patients possible and have been reported for single-vessel beating heart CABG via lateral thoracotomy. For multi-vessel revascularization the heart is usually approached via median sternotomy, therefore the use of TEA alone was applied in awake patients with multi-vessel coronary artery disease who underwent CABG via median sternotomy.

Single-dilator percutaneous tracheostomy: a comparison of PercuTwist and Ciaglia Blue Rhino techniques.

Objective: To compare two single-dilator percutaneous tracheostomy techniques, Ciaglia Blue Rhino and the new PercuTwist technique.

Design And Setting: Randomized, observational clinical trial in patients undergoing elective percutaneous tracheostomy in the intensive care units of a university hospital.

Patients: Seventy consecutive, adult patients undergoing either Blue Rhino ( n=35) or PercuTwist tracheostomy ( n=35).

Surgeon's occupational exposure to nitrous oxide and sevoflurane during pediatric surgery.

Health hazards from occupational exposure to trace concentrations of anaesthetic gases cannot be definitively excluded. The aim of the study was to determine the surgeon's occupational exposure to nitrous oxide and sevoflurane during pediatric surgical procedures. Twenty young children (age < 10 years) and five teenagers (age > 10 years) underwent elective abdominal surgery under general inhalational anesthesia.