Superinfections are a fundamental critical care problem, and their significance in severe COVID-19 cases needs to be determined. This study analyzed data from the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) cohort focusing on intensive care patients. A retrospective analysis of patient data from 840 cases of COVID-19 with critical courses demonstrated that co-infections were frequently present and were primarily of nosocomial origin. Furthermore, our analysis showed that invasive therapy procedures accompanied an increased risk for healthcare-associated infections. Non-ventilated ICU patients were rarely affected by secondary infections. The risk of infection, however, increased even when non-invasive ventilation was used. A further, significant increase in infection rates was seen with the use of invasive ventilation and even more so with extracorporeal membrane oxygenation (ECMO) therapy. The marked differences among ICU techniques used for the treatment of COVID-19-induced respiratory failure in terms of secondary infection risk profile should be taken into account for the optimal management of critically ill COVID-19 patients, as well as for adequate antimicrobial therapy.

During the COVID-19 pandemic, large numbers of elderly, multimorbid people required treatment in intensive care units. This study investigated how the inherent patient factors age and comorbidity burden affected the treatment strategy and the outcome achieved. Retrospective analysis of data from intensive care patients enrolled in the Lean European Open Survey on SARS-CoV2-Infected Patients (LEOSS) cohort found that a patient’s age and comorbidity burden in fact influenced their mortality rate and the use of ventilation therapy. Evidence showed that advanced age and multimorbidity were associated with the restrictive use of invasive ventilation therapies, particularly ECMO. Geriatric patients with a high comorbidity burden were clustered in the sub-cohort of non-ventilated ICU patients characterized by a high mortality rate. The risk of death generally increased with older age and accumulating comorbidity burden. Here, the more aggressive an applied procedure, the younger the age in which a majority of patients died. Clearly, geriatric, multimorbid COVID-19 patients benefit less from invasive ventilation therapies. This implies the need for a holistic approach to therapy decisions, taking into account the patient’s wishes.

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) plays an important role in the mostsevere trauma and medical patients with cardiac arrest. Its use in pre-hospital emergency medicine in Germany doesnot yet regularly occur, and the vast majority of rapid response vehicles are not equipped with REBOA devices. In thisarticle we will describe the introduction of REBOA for bleeding patients, as well as an adjunct for refractory out-of-hospitalcardiac arrest (OHCA), in a German helicopter emergency medical service (HEMS).Methods: The DRF-Luftrettung HEMS base in Halle (Saale) Germany has incorporated REBOA in pre-hospital emergencymedicine and will accompany this introduction with a feasibility study. We will describe the implementationof REBOA and the results of the training course. The training consists of theoretical and practical issues within differentcase scenarios. This was carried out before introducing REBOA into pre-hospital emergency medicine. Using a preand post-course exam and a self-assessment questionnaire the theoretical and practical knowledge and the performanceof the critical care teams were determined.Results: The results of the pre-course exam in comparison with the post-course exam improved from 82% to 96%. Basedon the self-assessment questionnaires, all participants felt a relevant improvement of their theoretical and practical knowledge.All physicians successfully performed REBOA under ongoing cardiopulmonary resuscitation in manikin simulators.Conclusions: The results from the training course indicate that there was a significant improvement of the theoreticaland practical knowledge, as well as the performance of REBOA. The on-going feasibility study will show if it is worthintroducing REBOA in a civilian HEMS for the patients in extremis.

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Zusammenfassung Anamnese Eine 21-jährige Patientin erlitt im Rahmen eines Unfalls ein schweres Strangulationstrauma. Stridor und Dyspnoe setzten erst mit Verzögerung ein und führten zur Notfallintubation. Befund Im Rahmen der klinischen Untersuchung zeigten sich Strangulationsmarken und ein Emphysem der Halsweichteile. Die Computertomographie erhärtete den Verdacht auf einen Abriss der Trachea vom Kehlkopf und ergab eine Fehllage des Beatmungstubus. Diagnose Bei der weiteren chirurgischen Exploration zeigte sich eine komplette laryngotracheale (krikotracheale) Separation. Therapie und Verlauf Nach initialer Nottracheotomie wurden in einem zweizeitigen operativen Verfahren die krikotracheale Reanastomosierung und die Retracheostomie durchgeführt. Schlussfolgerung Laryngotracheale Separationen stellen den höchsten Schweregrad der Kehlkopfverletzungen dar und sind mit einer hohen Mortalität behaftet. Im geschilderten Fall überlebte die Patientin und konnte, trotz beidseitiger Rekurrensparese, dekanüliert entlassen werden.