ÖGUM-Förderpreisträger 2010

Der ÖGUM-Förderpreis 2010 wurde den Herren Dr. Peter Michael Zechner (Jahrg. 1984, MU Graz) und Dr. Gernot Aichinger (Jahrg. 1982, LKH Villach) für ihre gemeinsame Arbeit über "The presence or absence of cardiac movement identifi ed on prehospital echocardiography predicts outcome in cardiac arrest patients" zuerkannt. Die Preisverleihung und ein Kurzreferat über ihre Arbeit fanden im Rahmen der Generalversammlung auf dem DLT in Mainz statt. Die ÖGUM hat mit diesem Preis wieder junge Wissenschaftler geehrt, die sich mit innovativen Ideen von Ultraschallanwendungen auseinandergesetzt haben. Beide Preisträger befinden sich noch in der Turnusausbildung zum Arzt für Allgemeinmedizin. Einen Abriss ihrer prämierten Arbeit fi nden Sie unten. Beiden Preisträgern einen herzlichen Glückwunsch und viele weitere (Ultraschall-) Erfolge in Ihrem Beruf !

The presence or absence of cardiac movement identifi ed on prehospital echocardiography predicts outcome in cardiac arrest patients, Zechner PM, Aichinger G, Prause G, Sacherer F, Wildner G, Anderson C, Pocivalnik M, Fox JC.

Introduction: The prognostic value of emergency echocardiography (EE) in the management of cardiac arrest patients has only been studied in the in-hospital setting. These studies mainly included patients who underwent CPR by emergency medicine technicians at the scene who arrived to the emergency department (ED) in cardiac arrest. In most European countries patients suff ering from cardiac arrest are normally treated by physician-staff ed EMS teams on-scene. Transportation to the ED while undergoing CPR is uncommon. The aim of our study was to evaluate the feasibility and accuracy of prehospital on-scene EE as a predictor of outcome in cardiac arrest patients.

Dr. G. Aichinger und Dr. P.-M. Zechner

Methods: Our research was a prospective observational study of nonconsecutive, non-trauma, adult cardiac arrest patients who were treated by physician-staff ed urban EMS teams on-scene. Participating emergency physicians (EP) received a four-hour course in focused echocardiography including video demonstrations, hands-on training and an introduction into an ultrasound algorithm conform with recent ALS guidelines. After obtaining initial stabilization procedures such as defi brillation, endotracheal intubation and vascular access, an EE was performed during a rhythm and pulse check using a 4-2 MHz microconvex transducer. A single subxiphoid, four-chamber view was required for study enrollment. We defi ned sonographic evidence of cardiac kinetic activity as any detected motion of the myocardium, ranging from visible ventricular fi brillation to coordinated ventricular contractions. CPR had to be continued for at least 15 minutes after the initial echocardiography in accordance.

Results: 42 patients were enrolled into the study. Feasibility was 100 %. Of the 42 study patients, fi ve (11.9 %) survived to hospital admission. Of the 32 patients who had cardiac standstill on initial EE, only one (3.1 %) survived to hospital admission, whereas 4 out of 10 (40 %) patients with cardiac movement on initial EE survived to hospital admission (p = 0.008). Neither asystole on inital ECG nor peak capnography values, age, bystander CPR or downtime were signifi cant predictors for survival in our study. Only cardiac movement was associated with survival and cardiac standstill at any time during CPR resulted in a positive predictive value of 97.1 % for death at the scene.

Conclusion: Our results support the idea of focused echocardiography as a valid predictor of outcome in CPR patients and demonstrate its feasibilty in the prehospital setting.