What do the Abcds of CPR do

Medicines held in reserve on emergency medical equipment in Germany

Summary

background

In the ambulance service, patient care should be based on evidence. In this study, the medical equipment of emergency medical equipment was recorded. For selected “tracer” diagnoses, the drug stocks were analyzed and compared with the need for guidelines.

method

From May 2008 to January 2009, all 148 Medical Heads of Rescue Service (ÄLRD) who worked at the federal office of the Federal Association of Medical Heads of Rescue Service Germany e. V. are registered, written to and asked to send their medication lists. The evaluation was carried out anonymously. "Cardiopulmonary resuscitation (CPR)", "acute coronary syndrome (ACS)", "status of generalized tonic-clonic seizures", "severe asthma attack" or "acute exacerbation of chronic obstructive pulmonary disease (COPD)", "narrow complex tachycardia" were used as tracer diagnoses "," Severe craniocerebral trauma (TBI) "and" acute heart failure with signs of hypoperfusion ". The current guidelines of the Working Group of Scientific Medical Societies e. V. served as a basis and were compared with international guidelines.

Results

The response rate was 64.2%; 39 groups of substances and 142 different drugs could be identified. The comparison of guidelines showed that with a frequency of around 30–80%, depending on the respective tracer diagnosis, acute drug therapy according to the highest level of evidence cannot be used.

conclusion

Based on current therapy recommendations, the equipment with noradrenaline, adenosine, dobutamine, sodium bicarbonate, calcium, magnesium, lorazepam for IV administration as well as ipratropium bromide and salbutamol (both as ready-to-use inhalants) should be improved. For the future, a uniform national minimum standard based on evidence-based principles is to be aimed for.

Abstract

Background

The emergency medical service (EMS) should work according to criteria of evidence-based medicine. In Germany the EMS of each state is under the control of at least one medical supervisor known as emergency medical directors (EMD) and most states have several different EMDs responsible for one or more provinces of the state. The German Medical Association advises these supervisors to specify the pharmacological resources in store for use in physician powered EMSs. This study examines the pharmacological resources in EMSs which is provided by the EMDs in Germany. Furthermore, a comparison of the inventory analysis of stored drugs was carried out with the requirements according to guidelines for selected tracer diagnoses.

Method

In the period from May 2008 to January 2009 a total of 148 EMDs were contacted and asked to supply drug storage lists for emergency physician-staffed rescue vehicles in their respective jurisdiction. The addresses of all EMDs who could be identified by the federal office of the National Association of Emergency Medical Director, Germany were used over the period. The evaluation was conducted anonymously. The tracer diagnoses “cardiopulmonary resuscitation”, “acute coronary syndrome”, “status generalized tonic-clonic seizure,” “severe asthma attack”, “acute exacerbation of chronic obstructive pulmonary disease”, “supraventricular tachycardia”, “severe brain trauma” and "Acute heart failure with signs of hypoperfusion" were selected. Current and established guidelines have been identified with the homepage of the Scientific Medical Societies in Germany and supported by the leading European and International guidelines.

Results

The corresponding lists were returned by 95 different emergency service areas (response rate 64.2%). With a total of 39 groups of substances 142 different drugs could be identified, an average of 54 ± 9.6 and median 55 (range 31–77). Listed are agents giving the provision in percent, for which the comparison with guidelines for tracer diagnoses could show deficits: sodium bicarbonate 75.8%, calcium 50.5%, magnesium 45.3%, noradrenaline 65.3%, adenosine 58.9%, dobutamine 57.9%, lorazepam iv 13.7 %, salbutamol 41.1%, ipratropium bromide 13.7% (the last two as liquid preparations for inhalation). With a frequency of about 30-80%, depending on the respective tracer diagnosis, no medical emergency treatment according to the highest level of evidence is possible.

Conclusion

Due to recent treatment recommendations provision with sodium bicarbonate, calcium, magnesium, noradrenaline, adenosine, lorazepam iv, dobutamine and as well with ipratropium bromide and salbutamol (both as liquid preparations for inhalation) should be improved. For the future, a federal uniform minimum standard due to evidence-based principles is desirable.

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literature

  1. 1.

    Ahnefeld FW, Dick W, Schuster HP (2000) Requirements for the equipment in the rescue service. Emergency Rescue Med 3: 64–71

    Article Google Scholar

  2. 2.

    Alldredge BK, Gelb AM, Isaacs SM et al (2001) A comparison of lorazepam, diazepam and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med 345: 631-637

    PubMedArticleCAS Google Scholar

  3. 3.

    Antman EM, Cohen M, Mccabe C et al (2002) Enoxaparin is superior to unfractionated heparin for preventing clinical events at 1-year follow-up of TIMI 11B and ESSENCE. Eur Heart J 23: 308-314

    PubMedArticleCAS Google Scholar

  4. 4.

    Antman EM, Louwerenburg HW, Baars HF et al (2002) Enoxaparin as adjunctive antithrombin therapy for ST-elevation myocardial infarction: results of the ENTIRE-Thrombolysis in Myocardial Infarction (TIMI) 23 Trial. Circulation 105: 1642-1649

    PubMedArticleCAS Google Scholar

  5. 5.

    Arntz HR, Bossaert L, Filippatos GS (2005) European Resuscitation Council guidelines for resuscitation 2005. Section 5. Initial management of acute coronary syndromes. Resuscitation 67 (Suppl 1): 87-96

    Article Google Scholar

  6. 6.

    Bateman ED, Hurd SS, Barnes PJ et al (2008) Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 31: 143-178

    PubMedArticleCAS Google Scholar

  7. 7.

    Behrendt H (2008) In: Number mirror rescue service - An overview of the most important key figures in the rescue service, 1st edition Mendel, Witten, S 23, Fig. 1. ISBN: 978-3-930670-44-4

  8. 8.

    Blomstrom-Lundqvist C, Scheinman MM, Aliot EM et al (2003) ACC / AHA / ESC guidelines for the management of patients with supraventricular arrhythmias - Executive summary: a report of the American College of Cardiology / American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol 42: 1493-1531

    PubMedArticle Google Scholar

  9. 9.

    Bratton SL, Chestnut RM, Ghajar J et al (2007) Guidelines for the management of severe traumatic brain injury. I. Blood pressure and oxygenation. J Neurotrauma 24 (Suppl 1): 7-13

    Google Scholar

  10. 10.

    Bratton SL, Chestnut RM, Ghajar J et al (2007) Guidelines for the management of severe traumatic brain injury. II. Hyperosmolar therapy. J Neurotrauma 24 (Suppl 1): 14-20

    Google Scholar

  11. 11.

    Bratton SL, Chestnut RM, Ghajar J et al (2007) Guidelines for the management of severe traumatic brain injury. IX. Cerebral perfusion thresholds. J Neurotrauma 24 (Suppl 1): 59-64

    Google Scholar

  12. 12.

    Federal office of the Federal Association of ÄLRD Germany e.V. (2010) http://www.bgs-aelrd.de

  13. 13.

    Cock HR, Schapira AH (2002) A comparison of lorazepam and diazepam as initial therapy in convulsive status epilepticus. QJM 95: 225-231

    PubMedArticleCAS Google Scholar

  14. 14.

    Cooper DJ, Myles PS, McDermott FT et al (2004) Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA 291: 1350-1357

    PubMedArticleCAS Google Scholar

  15. 15.

    Daly C, Clemens F, Lopez-Sendon JL et al (2006) The impact of guideline compliant medical therapy on clinical outcome in patients with stable angina: findings from the Euro Heart Survey of stable angina. Eur Heart J 27: 1298-1304

    PubMedArticle Google Scholar

  16. 16.

    Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 10: 933-989

    PubMedArticle Google Scholar

  17. 17.

    Diener HC, Putzki N (2008) Guidelines for Diagnosis and Therapy in Neurology, 4th revised. Ed. Thieme, Stuttgart, pp. 654 ff.

  18. 18.

    Diener HC, Putzki N (2005) Guidelines for Diagnostics and Therapy in Neurology, 3rd revised. Ed. Thieme, Stuttgart, pp. 20 ff.

  19. 19.

    Genzwurker H, Lessing P, Ellinger K et al (2007) Infrastructure of emergency medical services. Comparison of physician-staffed ambulance equipment in the state of Baden-Wuerttemberg in 2001 and 2005. Anaesthesist 56: 665-672

    PubMedArticleCAS Google Scholar

  20. 20.

    Gries A, Zink W, Bernhard M et al (2006) Realistic assessment of the physician-staffed emergency services in Germany. Anaesthesiologist 55: 1080-1086

    PubMedArticleCAS Google Scholar

  21. 21.

    Hamm CW (2004) Guidelines: Acute Coronary Syndrome (ACS). Part 1: ACS without persistent ST elevation. Z Kardiol 93: 72-90

    PubMedArticleCAS Google Scholar

  22. 22.

    Hamm CW (2004) Guidelines: Acute Coronary Syndrome (ACS). Part 2: Acute coronary syndrome with ST elevation. Z Kardiol 93: 324-341

    PubMedArticleCAS Google Scholar

  23. 23.

    Knuth P (2001) Which requirements have to be fulfilled for the equipment of life-saving appliances? Emergency Doctor 17: 28–34

    Article Google Scholar

  24. 24.

    Kushner FG, Hand M, Smith SC Jr et al (2009) 2009 Focused Updates: ACC / AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (updating the 2004 Guideline and 2007 Focused Update) and ACC / AHA / SCAI Guidelines on Percutaneous Coronary Intervention (updating the 2005 Guideline and 2007 Focused Update): a report of the American College of Cardiology Foundation / American Heart Association Task Force on Practice Guidelines. Circulation 120: 2271-2306

    PubMedArticle Google Scholar

  25. 25.

    Lelgemann M, Ollenschlager G (2006) Evidence based guidelines and clinical pathways: complementation or contradiction? Internist (Berl) 47: 690, 692-697

    Google Scholar

  26. 26.

    Mckay SE, Howie CA, Thomson AH et al (1993) Value of theophylline treatment in patients handicapped by chronic obstructive lung disease. Thorax 48: 227-232

    PubMedArticleCAS Google Scholar

  27. 27.

    Messelken M, Martin J, Milewski P (1998) Quality of results in emergency medicine, attempt to determine the location. Emergency Rescue Med 1: 143–149

    Article Google Scholar

  28. 28.

    Moecke H, Stratmann D (1995) Recommendations of the German Medical Association on the "Medical Director of Rescue Service". Emergency doctor 11:99

    Google Scholar

  29. 29.

    Murciano D, Auclair MH, Pariente R et al (1989) A randomized, controlled trial of theophylline in patients with severe chronic obstructive pulmonary disease. N Engl J Med 320: 1521-1525

    PubMedArticleCAS Google Scholar

  30. 30.

    National supply guidelines (NVL) "Asthma" and NVL "COPD" (S3 guidelines) (2010) http://www.copd.versorgungsleitlinien.de or http://www.asthma.versorgungsleitlinien.de

  31. 31.

    Nieminen MS, Bohm M, Cowie MR et al (2005) Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 26: 384-416

    PubMedArticle Google Scholar

  32. 32.

    Nolan JP, Deakin CD, Soar J et al (2005) European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation 67 (Suppl 1): 39-86

    Article Google Scholar

  33. 33.

    Nolan JP, Deakin CD, Soar J et al (2005) European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation 67 (Suppl 1): 39-86

    Article Google Scholar

  34. 34.

    Parameswaran K, Belda J, Rowe BH (2000) Addition of intravenous aminophylline to beta2-agonists in adults with acute asthma. Cochrane Database Syst Rev 4: CD002742

    PubMed Google Scholar

  35. 35.

    Paschen HR (2002) Equipment of life-saving appliances. Emergency Rescue Med 5: 410

    Article Google Scholar

  36. 36.

    Prasad K, Al-Roomi K, Krishnan PR et al (2005) Anticonvulsant therapy for status epilepticus. Cochrane Database Syst Rev: CD003723

    Google Scholar

  37. 37.

    Rabe KF, Hurd S, Anzueto A et al (2007) Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 176: 532-555

    PubMedArticle Google Scholar

  38. 38.

    Rickels E, Von Wild KRH, Wenzlaff P, Bock WJ (2006) Skull and brain injury - epidemiology and care: results of a prospective study, 1st edition. Zuckschwerdt, Germering near Munich

  39. 39.

    Rodrigo GJ, Rodrigo C (2000) First-line therapy for adult patients with acute asthma receiving a multiple-dose protocol of ipratropium bromide plus albuterol in the emergency department. Am J Respir Crit Care Med 161: 1862-1868

    PubMedCAS Google Scholar

  40. 40.

    Ross AM, Molhoek P, Lundergan C et al (2001) Randomized comparison of enoxaparin, a low-molecular-weight heparin, with unfractionated heparin adjunctive to recombinant tissue plasminogen activator thrombolysis and aspirin: second trial of Heparin and Aspirin Reperfusion Therapy (HART II ). Circulation 104: 648-652

    PubMedArticleCAS Google Scholar

  41. 41.

    Schmid MC, Deisenberg M, Strauss H et al (2006) Equipment of a land-based emergency medical service in Bavaria: a questionnaire. Anaesthesiologist 55: 1051-1057

    PubMedArticleCAS Google Scholar

  42. 42.

    Simoons M, Krzeminska-Pakula M, Alonso A et al (2002) Improved reperfusion and clinical outcome with enoxaparin as an adjunct to streptokinase thrombolysis in acute myocardial infarction. The AMI-SK study. Eur Heart J 23: 1282-1290

    PubMedArticleCAS Google Scholar

  43. 43.

    Federal Statistical Office (2008) http://www.destatis.de, as of December 31, 2008

  44. 44.

    Travers A, Jones AP, Kelly K et al (2001) Intravenous beta2-agonists for acute asthma in the emergency department. Cochrane Database Syst Rev 2: CD002988

    PubMed Google Scholar

  45. 45.

    Treiman DM, Meyers PD, Walton NY et al (1998) A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 339: 792-798

    PubMedArticleCAS Google Scholar

  46. 46.

    Wenzel V, Krismer AC, Arntz HR et al (2004) A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N Engl J Med 350: 105-113

    PubMedArticleCAS Google Scholar

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thanksgiving

The authors would like to thank all the ÄLRD who provided the drug lists for their area of ​​responsibility.

Conflict of interest

This study was carried out as part of the Med-on- @ ix research project. The research project is funded by the Federal Ministry of Economics and Technology, grant number 01MB07022. P3 Communications GmbH and Philips Medizingeräte GmbH bring in their own funds in addition to public funding.

Author information

Affiliations

  1. Clinic for Anaesthesiology, University Hospital Aachen, RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany

    Dr. D. Rörtgen, M. Skorning, S. Bergrath, S.K. Beckers, M. Coburn, J.C. Brokmann, H. Fischermann, M. Nieveler & R. Rossaint

  2. Clinic for Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Giessen and Marburg GmbH, Giessen, Germany

    A. Schaumberg

  3. Medical director of the City of Aachen Rescue Service, Aachen Professional Fire Brigade, Aachen, Germany

    J.C. Brokmann

Corresponding author

Correspondence to Dr. D. Rörtgen.

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Cite this article

Rörtgen, D., Schaumberg, A., Skorning, M. et al. Medicines held in reserve on emergency medical equipment in Germany. Anesthetist60, 312-324 (2011). https://doi.org/10.1007/s00101-010-1812-9

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keywords

  • Emergency medicine
  • Evidence-based emergency therapy
  • Drug therapy
  • Emergency medical service
  • Preclinical emergency care

Keywords

  • Emergency medicine
  • Evidence-based emergency medicine
  • Drug therapy
  • Emergency medical services
  • Prehospital emergency care