Sie können Operatoren mit Ihrer Suchanfrage kombinieren, um diese noch präziser einzugrenzen. Klicken Sie auf den Suchoperator, um eine Erklärung seiner Funktionsweise anzuzeigen.
Findet Dokumente, in denen beide Begriffe in beliebiger Reihenfolge innerhalb von maximal n Worten zueinander stehen. Empfehlung: Wählen Sie zwischen 15 und 30 als maximale Wortanzahl (z.B. NEAR(hybrid, antrieb, 20)).
Findet Dokumente, in denen der Begriff in Wortvarianten vorkommt, wobei diese VOR, HINTER oder VOR und HINTER dem Suchbegriff anschließen können (z.B., leichtbau*, *leichtbau, *leichtbau*).
The VA ECMO Registry of Germany (VERGE, http://va-ecmo-register.de/) is a prospective, multicenter, investigator-driven registry of Venoarterial Extracorporeal Membrane Oxygenation (VA ECMO) all-comers, free from industrial support. VERGE is Germany’s first multicenter registry to systematically gather and analyze data from various centers on the clinical use of VA ECMO. This first report compromises data from 581 VA ECMO patients from 2022. Median age was 60 years, hospital survival was 42% and 25% were female. The leading indication for VA ECMO was extracorporeal cardiopulmonary resuscitation (ECPR) followed by VA ECMO in shock (48.9 and 34.9%, respectively). Hospital survival of ECPR was significantly worse compared to shock (28 and 55%, respectively, p < 0.001). Age, pH, and lactate before cannulation all significantly correlated independently with hospital survival (p < 0.001). In VERGE, no patients with pH below 6.7 or lactate above 25 mmol/l survived.
Tobias Wengenmayer and Dawid L. Staudacher equally contributed.
Introduction
Venoarterial Extracorporeal Membrane Oxygenation (VA ECMO) represents a critical intervention in cardiovascular support, particularly for patients experiencing acute cardiac failure and cardiogenic shock [1, 2]. Although no large prospective randomized trials yet demonstrated the efficacy of VA ECMO in reducing mortality, the number of VA ECMO utilizations is growing [3]. In response to the growing use of such highly invasive procedures, a national registry of VA ECMO all-comers has been founded.
The aims of this report are (i) to give an overview of the usage of VA ECMO in Germany in 2022 and (ii) to correlate of the primary outcome with predictors of outcome in VA ECMO.
Anzeige
VERGE (VA ECMO Registry of Germany)
VERGE (http://va-ecmo-register.de/) is the inaugural registry in Germany dedicated to systematic collection and analysis VA ECMO clinical data. This prospective, multicenter, investigator-led registry includes all VA ECMO cases and operates without industrial funding. This registry is endorsed by the German Society for Cardiology—Cardiovascular Research (DGK) and the German Society for Thoracic and Cardiovascular Surgery (DGTHG) and is aimed at all ECMO therapy users. The registry is open to all professional societies and explicitly invites and encourages all professional societies involved in ECMO therapy to support and participate. There is a secondary option to include data retrospectively. Reports from VERGE aim to provide a foundational understanding of the clinical practice patterns, patient outcomes, and potential areas for quality improvement within the German healthcare system. Prospectively, data pool will continue to grow, and an annual report will be created from the aggregated data. Each participating center will receive a center-specific report upon completion of the national report to enable benchmarking. This approach will facilitate continuous improvement and allow each center to compare its performance with the national standards and other centers, fostering a collaborative environment aimed at enhancing overall patient outcomes.
Methods
In VERGE, anonymized data were collected from all participating centers in Germany and managed using REDCap (Research Electronic Data Capture) electronic data capture tools hosted at the University of Freiburg, Germany. REDCap is a secure, web-based software platform designed to support data capture for research studies [4, 5].
In VERGE, patient data categorization is mandatory. Each patient must be classified into one of the following categories based on their indication for treatment: ECPR, defined as venoarterial (VA) ECMO in patients without a stable return of spontaneous circulation (ROSC); VA ECMO for shock, applicable to all types of shock; peri-procedural VA ECMO, used as backup or to facilitate a procedure; or post-cardiotomy VA ECMO, implemented in the context of post-cardiotomy surgery. Only one category could be assigned to each patient.
We included all VA ECMO runs that began on or after January 1, 2022 to December 31, 2022 and were entered in the database by April 15, 2024. REDCap was configured to allow participating centers to see their own data only. Since this registry only comprises anonymized data presented aggregated and serves quality assurance purposes, no consent from patients was required as discussed with the ethics committee of Freiburg. Additionally, approval from regional ethics committees for the submission of data was deemed unnecessary. Data presented derive from 14 German centers, specifically.
University Hospital Regensburg, Germany
Asklepios Clinic St. Georg, Cardiology and Critical Care, Hamburg, Germany
University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Interdisciplinary Medical Intensive Care (IMIT), Faculty of Medicine and Medical Center, University of Freiburg, Germany
Heart and Vascular Center Bad Bevensen, Bad Bevensen, Germany
Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany
Department for Cardiology I: Coronary and Periphereal Vascular Disease, Heart Failure, University Hospital Münster, Germany
Department of Acute and Emergency Medicine, Elisabeth-Hospital Essen, Essen, Germany
Hospital of the Barmherzige Brüder, Trier, Germany
Department of Medicine I, LMU University Hospital, LMU Munich, Germany
University Heart Center Lübeck, Germany
SLK-Kliniken Heilbronn GmbH, Klinikum Am Gesundbrunnen, Medical Department I, Heilbronn, Germany
Department of Cardiology, Intensive Care Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Anzeige
Predictors
As for this research, only indication subgroups with at least 100 entries were further differentiated. Therefore, peri-procedural or post-cardiotomy patients were not investigated as separate subgroups in the current evaluation of the registry. The predictors of hospital survival were pre-defined including age and the biomarkers pH and lactate. The primary endpoint of this research was hospital survival.
Statistical analysis
Data are presented descriptively as counts and percentages, as well as medians and interquartile ranges (IQR) stratified by group or level. Missing values were excluded before calculating descriptive statistics (unless otherwise noted), and counts of missing values are provided, where applicable. Analysis was conducted in R Statistical Software Version 4.3.2 [6] and figures were produced using the package ggplot2 [7]. Differences between the groups were calculated using Kruskal–Wallis rank sum test, Wilcoxon rank sum test, Pearson’s chi-squared test or Fisher’s exact test, as applicable. A Pearson correlation analysis using the cor.test function in R and a binomial regression model using the glm function in R was performed to analyze the relationship between various pre-ECMO values and ICU survival. A p value < 0.05 was considered statistically significant.
Results
For 2022, a total of 581 patients from 14 centers were included in the VA ECMO registry of Germany (VERGE). The indications for VA ECMO support were pre-categorized into four subtypes: shock, ECPR, peri-procedural, and post-cardiotomy. The predominant indication was VA ECMO for ECPR with 48.9% and only 1% for peri-procedural support. Hospital survival was as follows: 28.2% for eCPR, 55.2% for shock, 28.6% for peri-procedural, and 59.8% for post-cardiotomy. Survivors of ECPR and VA ECMO for shock exhibited a dichotomous neurological outcome at the time of hospital discharge, characterized by either good neurological outcome (defined as Cerebral Performance Category [CPC] 1 or 2) or death (CPC 5). Among ECPR patients, 4.6% were discharged with a severe neurological impairment (CPC 3–4), opposed to 9.4% patients with VA ECMO for shock (p = 0.049), see Fig. 1 and Table 1.
Fig. 1
Indication and outcome of patients in VERGE. (A) shows indication for VA ECMO. Most patients are included either for shock or ECPR. (B) draws the survival according to the indication for VA ECMO. Survival is better in shock and post-cardiotomy than ECPR. The neurological outcome according to the CPC is displayed for ECPR (C) and shock (D). Most surviving patients are discharged with a favorable outcome (CPC 1–2) as shown in green
Patient characteristics of all patients included in VERGE. $Significance is calculated between the subgroups given in columns 4–6. The column 'N' denotes the overall sample size with available values for each variable, irrespective of group; percentages reflect solely the observed data without any imputation
The median ages for patients receiving VA ECMO support in VERGE were 61 years, similar in shock and ECPR (61 and 60 years, respectively), see Table 1. Survivors were significantly younger than non-survivors (p < 0.001), which was consistent only in the shock subgroup, see Fig. 2A, C, D. The median age for survivors was 60 (ECPR) and 59 years (shock), compared to 61.0 (ECPR) and 65.0 years (shock) for non-survivors (p = 0.103 and p < 0.001). Pearson correlation analysis revealed a significant but weak negative correlation between age and hospital survival (p < 0.001). A logistic regression analysis showed that each additional year of age was associated with a 1.97% decrease in the odds of hospital survival (OR = 0.980, p < 0.001) in all patients, see Supplemental Fig. 1.
Fig. 2
Age and outcome after VA ECMO. (A) shows the age at cannulation for VA ECMO survivors and non-survivors. Survivors were significantly younger. (B) shows a correlation of age at cannulation and survival. There was a significant correlation with worse prognosis in older patients. Age of survivors and non-survivors is shown for the two main subgroups ECPR (C) and shock (D). Survivors were younger in both groups, the difference was statistically significant only in shock patients (p = 0.103 and p < 0.001, respectively)
Lactate levels before cannulation (mmol/L) showed a significant difference between survivors and non-survivors. The median lactate level for survivors was 7.3, compared to 11.1 mmol/L for non-survivors (p < 0.001), see Supplemental Fig. 2. Logistic regression analysis indicated a strong and significant influence of lactate levels on survival probability (Fig. 3A, p < 0.001). For shock patients, lactate levels prior to implantation were significantly different between survivors and non-survivors. The median lactate level was 5.3 mmol/L for survivors compared to 9.0 mmol/L for non-survivors (p < 0.001). Similar results were detected in ECPR patients. The median lactate level was 9.0 and 12.4 mmol/L for survivors and non-survivors, respectively, p < 0.001).
Fig. 3
Lactate and outcome after VA ECMO. (A) shows hospital survival stratified by lactate before cannulation for VA ECMO. No patient survived with a lactate above 25 mmol/l. (B) Logistic regression of lactate before cannulation and survival. Survival approaches zero asymptotically with increasing lactate levels. Lactate before cannulation in survivors and non-survivors is shown for the two main subgroups ECPR (C) and shock (D). Survivors had significantly lower lactate values in both subgroups (both p = 0.001)
Additionally, the pH levels prior to implantation were significantly different, with a median pH of 7.19 for survivors and 7.10 for non-survivors (p < 0.001), see Supplemental Fig. 3. Regression analysis indicated a strong and significant influence of pH on survival (Fig. 4B, p < 0.001. For ECPR and shock patients, pH levels prior to implantation were significantly higher in survivors compared to non-survivors (both p < 0.001, see Fig. 4, Tables 2 and 3).
Fig. 4
pH and outcome after VA ECMO. (A) shows hospital survival stratified by pH before cannulation for VA ECMO. No patient survived with a pH below 6.7. (B) Logistic regression of lactate before cannulation and survival. Survival probability shows a sigmoidal shape asymptotically approaching zero survival at low pH levels and 100% survival at high pH levels. pH before cannulation in survivors and non-survivors is shown for the two main subgroups ECPR (C) and shock (D). Survivors again had significantly higher pH values in the ECPR subgroup (p < 0.001) but not in shock patients (p = 0.2)
Characteristics of patients in the ECPR subgroup divided by hospital survivors and non-survivors. The column 'N' denotes the overall sample size with available values for each variable, irrespective of group; percentages reflect solely the observed data without any imputation. § of whole subgroup with ECPR
Characteristics of patients in the ECPR subgroup divided by hospital survivors and non-survivors. The column 'N' denotes the overall sample size with available values for each variable, irrespective of group; percentages reflect solely the observed data without any imputation. § of whole subgroup with shock
CPC cerebral performance category, ECMO extracorporeal membrane oxygenation, ICU intensive care unit, IQR interquartile range
In a multivariate logistic regression analysis of hospital survival in all patients, all three investigated parameters evaluated here (age, lactate, and pH, p < 0.001, respectively) were independent predictors of survival (see, Supplemental Material 1).
Discussion
The establishment of VERGE, the first national VA ECMO registry in Germany provides a unique perspective on the implementation and outcomes of this life-sustaining technology. This first report highlights several important aspects of routine VA ECMO support.
Anzeige
Survival
Primary endpoint of this report was hospital survival—which varied significantly with the indication for ECMO. While survival was 58% in shock and 28% in ECRP. These are well in the range of the ELSO-report, stating 46% and 31%, respectively [8]. Data of randomized trials in VA ECMO in acute myocardial infarction associated shock show a similar 30-day survival of 52% [9]. Randomized data on ECPR had a comparable survival in the ECPR arm (32% CPC1-2 180-day survival [10] and 20% CPC 1–2 30-day survival [11]. These survival rated, however, cannot be directly compared as only CPC 1–2 survival was measured, follow-up was longer and not all patients revived an ECPR in this arm. In VERGE, CPC 1–2 at discharge was 23%. The poor survival rate of the peri-procedural group is alarming. As the number of patients in this subgroup is still extremely low, no further conclusions can be drawn. Other studies to peri-procedural ECMO show better results [12, 13].
Treatment
Compared to randomized studies, a relatively high proportion of LV venting (23%) was observed. For instance, patients included in the ECLS-SHOCK study were treated with a venting device in 5.8% of the cases [9]. In the first year of the registry's existence, it is too early to draw conclusions from this observation.
The length of intensive care unit (ICU) stay differed significantly between survivors and non-survivors. For patients in cardiogenic shock, the ICU stay was 20 days versus 9 days (p < 0.001), and for the cohort of eCPR patients, it was 20 days versus 2 days (p < 0.001). Given the resource-intensive nature of these therapies, the duration of such treatments must be carefully considered before initiating an ECMO program.
Age
The median age at cannulation was 61 years for patients undergoing VA ECMO for shock and 60 years for ECPR, underscoring a trend toward the higher utilization in older patients. This reflects a broader shift within the age spectrum and supports the well-documented correlation between increased age and reduced survival likelihood [14, 15]. Our findings corroborate the relationship between survival rates and age, yet they do not pinpoint a clear cutoff age that significantly alters outcomes, moreover, in our data correlation was weak. This absence of a definitive age threshold poses critical questions about the other potential factors influencing outcomes, which might be deduced from this comprehensive dataset. The fact that patients over the age of 80 are being treated with ECPR epitomizes the challenges faced by medical teams. These challenges are not solely clinical but encompass the timely and effective use of VA ECMO before complete patient information is available.
Anzeige
Biomarkers
The lactate levels in surviving shock patients had a median of 5.3 mmol/L, similar to those of the patients enrolled in the ECLS Shock trial [9], while non-survivors exhibited significantly higher levels. A correlation of prognosis and lactate has been shown earlier [16]. Similarly, in ECPR patients, lactate levels were significantly different between survivors and non-survivors. Logistic regression analysis demonstrated a substantial influence of lactate levels on survival probability. It is not known how many centers are capable of measuring lactate levels above 20 or 25 mmol/L. This may have affected the categorization into lactate groups. However, in VERGE, no patient with a lactate above 25 mmol/L survived, which might be a cornerstone for Indication for VA ECMO.
Further conclusions may be drawn from aggregated data in subsequent years. Moreover, the pH was a strong predictor of survival in both ECPR as well as shock. Importantly, pH itself is an aggregate of respiratory and metabolic acid–base disturbances and, therefore, linked to lactate. With data shown here, we cannot differentiate between respiratory or metabolic acidosis. In VERGE, no patient with a pH below 6.7 survived and prognosis was best in patients with an alkalosis. These registry data, however, cannot be used to justify a hyperventilation strategy of VA ECMO patients and further research is needed.
Limitations
The reported data are subject to a reporting bias. The 14 contributing centers all have a high level of ECMO activity and a stronger inclination toward scientific research, meaning that the report does not yet reflect the true state of patient care across Germany. With the annual publication of the registry, the number of participating centers is expected to increase. The aim of this registry is to provide a comprehensive description of the VA ECMO landscape in Germany. A concise data structure is essential to ensure high adherence to the registry, which may result in some imprecise definitions. For instance, unlike in prospective randomized studies, the definition of cardiogenic shock was left to the discretion of the participating centers.
Conclusion
VERGE is the first national VA ECMO registry in Germany. Survival in the registry is similar to randomized data and the ELSO registry. Hospital survival independently correlated with age, lactate, and pH.
Anzeige
Acknowledgements
We thank all the participating centers, healthcare professionals, and administrative staff involved in this national effort. VERGE was supported by the ministry of Science, Research and Arts Baden-Württemberg. We thank Achim Lother for contributing with BioRender to the graphical abstract. VERGE Studygroup: Dirk Lunz, Department of Anesthesiology, University Hospital Regensburg, Germany and Thomas Müller, Department of Internal Medicine II, University Hospital Regensburg, Germany. Adrian Springer and Piotr Foszcz, Asklepios Clinic St. Georg, Cardiology and Critical Care, Hamburg, Germany and DZHK—Deutsches Zentrum für Herz-Kreislauf-Forschung, Germany. Benedikt Schrage (Department of Cardiology) and Stefan Kluge (Department of Intensive Care Medicine), University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Alexander Supady, Interdisciplinary Medical Intensive Care (IMIT), Faculty of Medicine and Medical Center, University of Freiburg, Germany and Sven Maier, Department of Cardiovascular Surgery, Faculty of Medicine and Medical Center, University of Freiburg, Germany. Aiman Alken, Heart and Vascular Center Bad Bevensen, Bad Bevensen, Germany. Ingo Sagoschen, Department of Anesthesiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany. Felix Rosenow and Jan Sackarnd, Department for Cardiology I: Coronary and Periphereal Vascular Disease, Heart Failure, University Hospital Münster, Germany. Stefan Leinen, Department of Emergency Medicine, Hospital of the Barmherzige Brüder, Trier, Germany. Felix Michelson und Jan-Philipp Simon, Department of Medicine I, LMU University Hospital, LMU Munich, Germany. Sven Siemonsen und Sebastian Becker, Department of Cardiology, Intensive Care Medicine, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany. Sverrir Möller, University Heart Center Lübeck, Germany. Marcus Hennersdorf and Sebastian Münz, SLK-Kliniken Heilbronn GmbH, Klinikum Am Gesundbrunnen, Medical Department I, Heilbronn, Germany. Simone Britsch und Simon Lindner (German Centre for Cardiovascular Research (DZHK), Mannheim, Germany; European Centre for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Emergency Medicine, Hospital of the Barmherzige Brüder, Trier, Germany)
Declarations
Conflict of interest
Tobias Wengenmayer is the Deputy Speaker of the German Society of Cardiology's Working Group 42. Guido Michels, Dawid Staudacher, and Eike Tigges are members of the nucleus of Working Group 42 of the German Society of Cardiology.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Clinical use and predictors of outcome in venoarterial extracorporeal membrane (VA ECMO): insights from VERGE (VA ECMO Registry of Germany)
Verfasst von
Tobias Wengenmayer
Dawid L. Staudacher
Alois Philipp
Eike Tigges
Angela Dettling
Hendrik Busse
Marc Kriege
Jan-Sören Padberg
Ingo Voigt
Clemens Scherer
Tobias Graf
Dominik Scharpf
Peter Noack
Simone Britsch
Guido Michels
the VERGE Study Group
Paddock S, Meng J, Johnson N, Chattopadhyay R, Tsampasian V, Vassiliou V (2024) The impact of extracorporeal membrane oxygenation on mortality in patients with cardiogenic shock post-acute myocardial infarction: a systematic review and meta-analysis. Eur Hear J Open 4:3. https://doi.org/10.1093/ehjopen/oeae003CrossRef
2.
Albulushi A, Tawfek A, Lawatia HA (2024) Evaluating the efficacy and safety of temporary mechanical circulatory support devices in acute cardiogenic shock: a subgroup-specific systematic review. Curr Probl Cardiol 49:102619. https://doi.org/10.1016/j.cpcardiol.2024.102619CrossRefPubMed
3.
Lang CN, Kaier K, Zotzmann V, Stachon P, Pottgiesser T, Muehlen C et al (2021) Cardiogenic shock: incidence, survival and mechanical circulatory support usage 2007–2017-insights from a national registry. Clin Res Cardiol 110:1421–1430. https://doi.org/10.1007/s00392-020-01781-zCrossRefPubMed
4.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381. https://doi.org/10.1016/j.jbi.2008.08.010CrossRefPubMed
Thiele H, Zeymer U, Akin I, Behnes M, Rassaf T, Mahabadi AA et al (2023) Extracorporeal life support in infarct-related cardiogenic shock. N Engl J Med. https://doi.org/10.1056/nejmoa2307227CrossRefPubMed
10.
Belohlavek J, Smalcova J, Rob D, Franek O, Smid O, Pokorna M et al (2022) Effect of intra-arrest transport, extracorporeal cardiopulmonary resuscitation, and immediate invasive assessment and treatment on functional neurologic outcome in refractory out-of-hospital cardiac arrest. JAMA 327:737–747. https://doi.org/10.1001/jama.2022.1025CrossRefPubMedPubMedCentral
11.
Suverein MM, Delnoij TSR, Lorusso R, Bruinsma GJBB, Otterspoor L, Kraemer CVE et al (2023) Early extracorporeal CPR for refractory out-of-hospital cardiac arrest. N Engl J Med 388:299–309. https://doi.org/10.1056/nejmoa2204511CrossRefPubMed
12.
van den Buijs DMF, Wilgenhof A, Knaapen P, Zivelonghi C, Meijers T, Vermeersch P et al (2022) Prophylactic impella CP versus VA-ECMO in patients undergoing complex high-risk indicated PCI. J Interv Cardiol 2022:8167011. https://doi.org/10.1155/2022/8167011CrossRefPubMedPubMedCentral
13.
Bulnes JF, Martínez A, Sepúlveda P, Fuensalida A, Besa S, Garrido L et al (2024) Outcomes of a modified, low-cost, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for elective, periprocedural support of high-risk percutaneous cardiac interventions: an experience from a latinamerican center. Perfusion 39:998–1005. https://doi.org/10.1177/02676591231178413CrossRefPubMed
14.
Fernando SM, MacLaren G, Barbaro RP, Mathew R, Munshi L, Madahar P et al (2023) Age and associated outcomes among patients receiving venoarterial extracorporeal membrane oxygenation–analysis of the Extracorporeal Life Support Organization registry. Intensiv Care Med 8:1–11. https://doi.org/10.1007/s00134-023-07199-1CrossRef
Fuernau G, Desch S, de Waha-Thiele S, Eitel I, Neumann F-J, Hennersdorf M et al (2020) Arterial lactate in cardiogenic shock: prognostic value of clearance versus single values. JACC Cardiovasc Interv 13:2208–2216CrossRefPubMed
Neue Studien haben 2025 praxisrelevante Informationen zur Behandlung von Patienten mit Vorhofflimmern geliefert, so etwa zur Antikoagulation bei gleichzeitiger Koronarerkrankung sowie zum möglichen Verzicht auf Antikoagulation nach Katheterablation.
Das Ausmaß der Myokardischämie und die Schwere der pektanginösen Symptome stehen bei stabiler KHK in keiner engen Beziehung. Warum das so ist, hat eine britische Forschergruppe versucht zu ergründen.
Bluthochdruck wird trotz klarer Leitlinien noch immer zu selten korrekt erkannt und konsequent behandelt. Ein aktueller Übersichtsartikel fasst typische Fehlerquellen von der Blutdruckmessung über die Diagnostik bis hin zur Therapie zusammen und zeigt, wie sich die Versorgung mit einfachen Maßnahmen verbessern lässt.
Erhöhte kardiale Troponine gelten als Schlüsselmarker des Myokardinfarkts. In seltenen Fällen beruhen stark erhöhte Werte jedoch nicht auf einer Myokardschädigung, sondern auf Störfaktoren. Wie sollte man mit einem derartigen Verdacht umgehen?
In diesem CME-Kurs können Sie Ihr Wissen zur EKG-Befundung anhand von zwölf Video-Tutorials auffrischen und 10 CME-Punkte sammeln.
Praxisnah, relevant und mit vielen Tipps & Tricks vom Profi.
