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Report from the First German – Austrian – Swiss Conference of Aspects of Circulatory Arrest in Berlin

By Currents Editor posted 01-16-2020 09:44

  

By Jens Nee1, Erich Schmutzhard2, Raimund Helbok3 

  1. Medical Department, Divison of Nephrology and Intensive Care Medicine - Circulatory Arrest Center, Charité

University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany.

  1. Department of Neurology, Neurocritical Care, Medical University of Innsbruck,

Innsbruck, Austria.

  1. Department of Neurology, Neurocritical Care, Medical University of Innsbruck,

Innsbruck, Austria. 

Berlin1.jpgThe first Berlin Circulatory Arrest Symposium took place in November 2019. The goal of this symposium was to discuss various medical and nursing aspects related to circulatory arrest using an interdisciplinary approach: from prehospital care to the management in the emergency room and in the intensive care unit (ICU) with special focus on neuroprognostication, nursing care, rehabilitation and long-term outcomes.

Each phase of the patient care after resuscitation has its own challenges, including the logistical challenge in the prehospital care and the emergency room, the challenging management in the ICU with the complex diagnostic approach, therapeutic and rehabilitative requirements. Intrahospital management should include an interdisciplinary team of (neuro)intensive care physicians, cardiologists, neurologists, nurses and rehabilitation staff. The focus of the Berlin symposium was the multidisciplinary management of patients after circulatory arrest. Berlin2.jpg

Congress presidents were Erich Schmutzhard (Innsbruck) and Jens Nee (Berlin). The program was carefully designed by an interdisciplinary team of specialists. 

The Keynote lecture was given by Helge Braun, head of the Federal Chancellery and Federal Minister of Special Tasks. Helge Braun is also a doctor and emphasized the important aspects of lay resuscitation in the survival chain. The minister was not present personally and sent a video message. 

The presentations on the first day focused on preclinical-, clinical primary care and ICU management. Therapeutic concepts of out-of-hospital resuscitation and in-hospital resuscitation were discussed from different angles. One major aspect was the care of patients with ongoing resuscitation in the light of ECLS/extracorporeal resuscitation, which is becoming increasingly important. The various concepts using examples from Hannover (Hannoverian shock room concept, Hannover Medical School - MHH) and from Berlin (intensive shock room concept, Charité, Circulatory Arrest Center) were presented. Not only does the insertion of an ECMO with ongoing resuscitation have its logistical difficulties, but the ongoing treatment with therapy for the cause of the cardiovascular arrest and the post-resuscitation syndrome with frequent multi-organ failure is also a special challenge. 

Berlin3.jpgThe importance of cardiac arrest centers, which are currently being certified in Germany, was highlighted in another lecture. The major question is if CA-patients would benefit from cardiac arrest centers. Only prospective studies would be able to provide a scientific-based answer to this question; however, some studies already provide evidence for a benefit from such treatment pathways. 

Targeted temperature management (TTM) should always be part of a therapeutic bundle in the post-resuscitation treatment. Professor Behringer from Jena presented current studies regarding TTM and practical issues, including how to best approach this challenge. 

At the end of the first day, great attention was paid to an intensive discussion of neurological prognosis in general and neuroprognostication after successful resuscitation. Above all, the possibilities of early predication under TTM were discussed. 

On the second day, unique challenges after circulatory arrest, including the post-ICU syndrome, were discussed. Another topic was the diagnosis and therapy of convulsive and non-convulsive status epilepticus post-cardiac arrest. Berlin4.jpg

Post-resuscitation therapy is always a multidisciplinary treatment; therefore, lectures from the nursing side were included that focused on the optimized intensive care management of a patient after successful resuscitation. Based on the outcome prediction, withdrawal of care and limitation of specific therapies were discussed. These issues were critically reviewed from both nursing and medical points of view but also from a legal perspective with the help from Dr. Mike Peters, a lawyer from Berlin.

More than 170 attendees from various medical specializations and nursing contributed to this symposium and exchanged their own experiences. Lively discussions between the participants took place during the breaks. For many, there was the opportunity to plan new, sometimes international, scientific collaboration. 

Overall, the organizers agreed that this symposium should be repeated with the various facets around the topic of resuscitation. We appreciate the organization supported by ZOLL Medical Deutschland GmBH.

#LeadingInsights 

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