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Introduction
Skills and Expertise
Publications
Publications (544)
In Germany, physicians qualify for emergency medicine by combining a specialty medical training—e.g. internal medicine—with advanced training in emergency medicine according to the statutes of the State Chambers of Physicians largely based upon the Guideline Regulations on Specialty Training of the German Medical Association. Internal medicine and...
The mortality of patients with MI has significantly decreased in recent decades, mainly due to early reperfusion therapy with a probability of surviving of more than 90% if the patient reaches the hospital [...]
Background/Introduction
In Europe, over 30.000 persons per year suffer from out-of-hospital cardiac arrest (OHCA). Despite medical progress, survival rates with good neurological outcome remain low. For many important clinical issues, no or only insufficient evidence from randomised trials is available. Therefore, a systemic and standardised acquis...
Background/Introduction
Heart failure (HF) is frequently complicated by atrial fibrillation (AF). The co-occurrence of both conditions worsens the overall patient prognosis (1). To reduce the risk of thromboembolic complications, current guidelines highly recommend an oral anticoagulant (OAC) therapy in the majority of patients affected (2).
Purpo...
Zusammenfassung
Mechanische Kreislaufunterstützungssysteme (engl. Mechanical Circulatory Support, MCS) haben in den letzten Jahren eine zunehmende Bedeutung in der akutmedizinischen Therapie des kritisch kranken Patienten im Schock erlangt. Aktuell stehen in Europa verschiede Systeme zur Verfügung, die sich in Wirkweise und Einsatzgebiet signifikan...
Extracorporeal cardiopulmonary resuscitation (ECPR) to improve outcomes in out-of-hospital cardiac arrest (OHCA) patients has gained widespread interest. Observational studies and a randomized trial indicate better outcomes for OHCA patients who receive ECPR over traditional resuscitation; this includes increased survival to hospital discharge and...
Background
The timely integration of palliative care is important for patients suffering from various advanced diseases with limited prognosis. While a German S-3-guideline on palliative care exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for integration of palliative care into intensive care...
Patients with potential or proven cardiovascular diseases represent a relevant proportion of the total spectrum in the emergency department. Their monitoring for cardiovascular surveillance until the diagnostics and acute treatment are initiated, often poses an interdisciplinary and interprofessional challenge, because resources are limited, nevert...
Patients with potential or proven cardiovascular diseases represent a relevant proportion of the total spectrum in the emergency department. Their monitoring for cardiovascular surveillance until the diagnostics and acute treatment are initiated, often poses an interdisciplinary and interprofessional challenge, because resources are limited, nevert...
Patients with potential or proven cardiovascular diseases represent a relevant proportion of the total spectrum in the emergency department. Their monitoring for cardiovascular surveillance until the diagnostics and acute treatment are initiated, often poses an interdisciplinary and interprofessional challenge, because resources are limited, nevert...
Point-of-care sonography is a precondition in acute and emergency medicine for the diagnosis and initiation of therapy for critically ill and injured patients. While emergency sonography is a mandatory part of the training for clinical acute and emergency medicine, it is not everywhere required for prehospital emergency medicine. Although some medi...
Zusammenfassung
Die Point-of-Care-Sonografie ist in der Akut- und Notfallmedizin ein fester Bestandteil der Diagnostik und Therapieeinleitung von kritisch kranken und verletzten Patienten. Während die Notfallsonografie im Rahmen der Zusatzweiterbildung für klinische Akut- und Notfallmedizin vorausgesetzt wird, wird diese für die prähospitale Notfal...
Point-of-care sonography is a precondition in acute and emergency medicine for the diagnosis and initiation of therapy for critically ill and injured patients. While emergency sonography is a mandatory part of the training for clinical acute and emergency medicine, it is not everywhere required for prehospital emergency medicine. Although some medi...
Aims:
Takotsubo syndrome (TTS) is associated with a substantial rate of adverse events. We sought to design a machine-learning (ML) based model to predict the risk of in-hospital death and to perform a clustering of TTS patients to identify different risk profiles.
Methods and results:
A Ridge Logistic Regression-based ML model for predicting in...
The timely integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S‑3-guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive...
The timely integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S‑3-guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive...
The timely integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S‑3-guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive...
The timely integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S‑3-guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive...
Zusammenfassung
Die zeitgerechte Integration der Palliativmedizin ist ein wichtiger Bestandteil in der medizinischen Behandlung von verschiedenen Erkrankungen im fortgeschrittenen Stadium. Während eine erweiterte S3-Leitlinie zur Palliativmedizin für Patienten mit einer nicht heilbaren Krebserkrankung existiert, fehlt bis dato eine Leitlinie für ni...
The integration of palliative medicine is an important component in the treatment of various advanced diseases. While a German S3 guideline on palliative medicine exists for patients with incurable cancer, a recommendation for non-oncological patients and especially for palliative patients presenting in the emergency department or intensive care un...
Background and objective:
Despite a measurable increase in recent years, the bystander resuscitation rate in Germany lags behind the European comparison. Special centers for the care of patients after cardiac arrest, so-called cardiac arrest centers (CAC), have been established. The aim of this work is to evaluate the role of CACs, in addition to...
Background: Aim of this study was to test if oral anticoagulant (OAC) use in patients with heart failure (HF), accompanied by atrial fibrillation (AF), leads to a favorable outcome. Further, the specific impact of non-vitamin K oral anticoagulants (NOACs) is analyzed.
Methods: Anonymous data from all patients with a health insurance at the largest...
Acute gastrointestinal emergencies are one of the most common presentations to the emergency department. If the main symptom is acute abdominal pain, this is referred to as "acute abdomen". An acute abdomen demands urgent attention and treatment and can be caused by different pathologies (e.g., peptic ulcer disease, acute pancreatitis, diverticulit...
Zusammenfassung
In diesem Empfehlungspapier werden zentrale Vorschläge für den Besuch von Kindern auf Intensivstationen (Pädiatrie und Erwachsenenbereich), Intermediate-care-Stationen und in Notaufnahmen vorgestellt. Auf Intensivstationen und in Notaufnahmen im deutschsprachigen Raum werden die Besuchsregelungen für Kinder und Jugendliche sehr hete...
Zusammenfassung
Die zeitgerechte Integration der Palliativmedizin ist ein wichtiger Bestandteil in der medizinischen Behandlung von verschiedenen Erkrankungen im fortgeschrittenen Stadium. Während eine erweiterte S3-Leitlinie zur Palliativmedizin für Patienten mit einer nicht heilbaren Krebserkrankung existiert, fehlt bis dato eine Leitlinie für ni...
Background:
Adrenomedullin is a free circulating peptide that regulates endothelial barrier function and vascular tone. Here, we sought to study the relationship of adrenomedullin in combination with lactate and the risk of death in patients with out-of-hospital cardiac arrest (OHCA).
Methods:
Mid-regional pro-ADM (MR-proADM) and lactate concent...
With increasing age in addition to alterations of the cardiovascular, neurocognitive and musculoskeletal systems, alterations also occur in hepatic organ function. As a result of morphological and functional age-related processes, progressive hepatic organ dysfunction can develop with increased vulnerability with respect to endogenous and exogenous...
Brauchle, M., Deffner, T., Nydahl, P., Brinkmann, A., Dehner, S., Dubb, R., Finkeldei, S., Gatzweiler, B., Hermes, C., Heyd, C., Hoffmann, M., Jeitziner, M.-M., Kaltwasser, A., Kern, T., Knochel, K., Krüger, L., Melching, H., Michels, G., Müller-Wolff, T., … Ufelmann, M. (2023). Ten recommendations for child-friendly visiting policies in Critical C...
Background
Temperature control is recommended after out of hospital cardiac arrest (OHCA) by international guidelines. This survey aimed to investigate current clinical practice and areas of uncertainty.
Methods
Online survey targeting members of three medical emergency and critical care societies in Germany (April 21–June 6, 2022) assessing post-...
Background:
Critical Care Providers (CCPs) experience situations that challenge their ethics and professional standards and may entail moral distress (MD).
Aim:
To analyze MD perceived by CCPs in intensive care units (ICUs) or emergency departments (EDs) and further clarify whether CCPs who rely on spiritual resources differ in their perception...
Contrast-enhanced ultrasonography (CEUS) is a widely available and well-tolerated technique that can expand the diagnosis of a variety of vascular liver diseases. This paper presents an overview of the current possibilities of the use of CEUS in vascular liver diseases. Particularly where Doppler sonography has technical limitations, CEUS provides...
The inodilator levosimendan, in clinical use for over two decades, has been the subject of extensive clinical and experimental evaluation in various clinical settings beyond its principal indication in the management of acutely decompensated chronic heart failure. Critical care and emergency medicine applications for levosimendan have included post...
Background
Improved imaging modalities contributed to increasing awareness of cardiac amyloidosis. Contemporary data on frequency trends in Germany are lacking.
Methods
In a retrospective study using health claims data of a German statutory health insurance, patients with diagnostic codes of amyloidosis and concomitant heart failure between 2009 a...
Zusammenfassung
In den vergangenen Jahren hat der Einsatz mechanischer Unterstützungssysteme für Patienten mit Herz- und Kreislaufversagen kontinuierlich zugenommen, sodass in Deutschland mittlerweile jährlich etwa 3000 ECLS-/ECMO-Systeme implantiert werden. Vor dem Hintergrund bislang fehlender umfassender Leitlinien bestand ein dringlicher Bedarf...
Zusammenfassung
Hintergrund
Zu Beginn der Coronaviruspandemie wurde eine Überlastung der verfügbaren intensivmedizinischen Ressourcen befürchtet. Vielerorts wurden Routineeingriffe eingeschränkt und Kriterien für die Zuteilung knapper Ressourcen formuliert. In Deutschland kam es regional im Verlauf der Pandemie zeitweise zu Überlastungssituationen...
Background
In Germany, 70,000–100,000 persons per year suffer from out-of-hospital cardiac arrest (OHCA). Despite medical progress, survival rates with good neurological outcome remain low. For many important clinical issues, no or only insufficient evidence from randomised trials is available. Therefore, a systemic and standardised acquisition of...
Zusammenfassung
In den vergangenen Jahren hat der Einsatz mechanischer Unterstützungssysteme für Patienten mit Herz- und Kreislaufversagen kontinuierlich zugenommen, sodass in Deutschland mittlerweile jährlich etwa 3000 ECLS/ECMO-Systeme implantiert werden. Vor dem Hintergrund bislang fehlender umfassender Leitlinien bestand ein dringlicher Bedarf...
Staphylococcus aureus (SA) and Streptococcus species (SS) show different clinical manifestations in infective endocarditis (IE), but the impact on the complexity of surgical treatment remains unclear. All patients with surgically treated IE due to SA or SS between July 2013 and December 2016 were extracted from a prospectively collected, single-cen...
Acute decompensation in patients with liver cirrhosis is characterized by the development of ascites, gastrointestinal bleeding, hepatic encephalopathy, or bacterial infection and is often accompanied by further extrahepatic organ dysfunction. Since critically ill patients with decompensated cirrhosis have a high mortality risk, rapid identificatio...
In hospitals providing extended and complex emergency care, an observation ward is a mandatory requirement. However, the function of the stationary setting of an emergency department has not been clearly clarified to date. Taking into account the G‑BA (German Federal Joint Committee) decision and the empirical values in clinical acute and emergency...
In this article, the affiliation details for Dominic Witzke
were incorrectly given as ’Department of Infectious
Diseases, Evangelisches Klinikum Bethel, Bielefeld,
Germany’, but should have read instead ’Department of
Anaesthesiology, Intensive Care, Protestant Hospital of
the Bethel Foundation, University Hospital of Bielefeld,
Campus Bielefeld-Be...
Acute respiratory distress syndrome (ARDS) and cardiogenic shock are common reasons for deterioration of patients admitted to intensive care units (ICU). Therapeutic options for severe ARDS vary from lung-protective mechanical ventilation to proning and may result in veno-venous extracorporeal membrane oxygenation. These range, particularly for car...
Health workers (HW) are at increased risk for SARS-CoV-2 infection. In order to monitor the infection dynamic on the basis of contact with patients, HW at the St. Antonius Hospital (SAH) were tested four times in one year by PCR and serology. The cumulative incidence of infection in HW was calculated. Swab and blood tests were simultaneously perfor...
Background
Ethnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes.
Methods
TTS patients in Japan were...
Purpose:
Insufficient antimicrobial exposure is associated with worse outcomes in sepsis. We evaluated whether therapeutic drug monitoring (TDM)-guided antibiotic therapy improves outcomes.
Methods:
Randomized, multicenter, controlled trial from January 2017 to December 2019. Adult patients (n = 254) with sepsis or septic shock were randomly ass...
The present document describes the possible applications of contrast-enhanced ultrasound (CEUS) in emergency examinations. Guidelines on contrast medium ultrasound in acute and emergency care and intensive care medicine have not yet been published. Evidence-based CEUS guidelines were first provided by the European Federation of Societies for Ultras...
Decisions with considerable medical and ethical implications are made in emergency departments every day. Despite time pressure and high workloads, they have to be arrived at in an expert manner in all dimensions. For immediate ethical decisions, structuring the decision-making process in the form of standard procedures can be helpful, provided tha...
The European guidelines on cardiopulmonary resuscitation, which are divided into 12 chapters, have recently been published. In addition to the already known chapters, the topics “epidemiology” and “life-saving systems” have been integrated for the first time. For each chapter five practical key statements were formulated. In the present article the...
The European guidelines on cardiopulmonary resuscitation, which are divided into 12 chapters, have recently been published. In addition to the already known chapters, the topics “epidemiology” and “life-saving systems” have been integrated for the first time. For each chapter five practical key statements were formulated. In the present article the...
Cardiac alterations are frequently observed after acute neurological disorders. Takotsubo syndrome (TTS) represents an acute heart failure syndrome and is increasingly recognized as part of the spectrum of cardiac complications observed after neurological disorders. A systematic investigation of TTS patients with neurological disorders has not been...
Aims Worldwide applications of extracorporeal circulation for mechanical support in cardiac and circulatory failure, which are referred to as extracorporeal life support (ECLS) or veno-arterial extracorporeal membrane oxygenation (va-ECMO), have dramatically increased over the past decade. In spite of the expanding use and the immense medical as we...
In Germany, a remarkable increase regarding the usage of extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) systems has been observed in recent years with approximately 3000 ECLS/ECMO implantations annually since 2015. Despite the widespread use of ECLS/ECMO, evidence-based recommendations or guidelines are still lack...
In Germany, a remarkable increase regarding the usage of extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) systems has been observed in recent years with approximately 3000 ECLS/ECMO implantations annually since 2015. Despite the widespread use of ECLS/ECMO, evidence-based recommendations or guidelines are still lack...
In Germany, a remarkable increase regarding the usage of extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) systems has been observed in recent years with approximately 3000 ECLS/ECMO implantations annually since 2015. Despite the widespread use of ECLS/ECMO, evidence-based recommendations or guidelines are still lack...
The curriculum cardiovascular intensive care and emergency medicine describes a training process to acquire an additional qualification, which exceeds the basic training in intensive care and emergency medicine essential for general and invasive cardiology board certification. During a cumulative period of 24 months, including the 18-month training...
Acute decompensation in patients with liver cirrhosis is characterized by the development of ascites, gastrointestinal bleeding, hepatic encephalopathy, or bacterial infection and is often accompanied by further extrahepatic organ dysfunction. Since critically ill patients with decompensated cirrhosis have a high mortality risk, rapid identificatio...
Extracorporeal cardiopulmonary resuscitation (ECPR) to improve outcomes in out-of-hospital cardiac arrest (OHCA) patients has gained widespread interest. Observational studies and a randomized trial indicate better outcomes for OHCA patients who receive ECPR over traditional resuscitation; this includes increased survival to hospital discharge and...
A cirrhotic cardiomyopathy (CCM) can be observed in patients with end-stage liver disease and is characterized by a systolic and/or diastolic dysfunction in the absence of pre-existing heart diseases. While the cardiac dysfunction is often masked at rest, it typically manifests itself during cardiovascular challenges such as hypovolemia, physical s...
Background
Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS.
Metho...
