Johannes von Vopelius-Feldt

Bio: Johannes von Vopelius-Feldt is an academic researcher from University of the West. The author has contributed to research in topics: Systematic review & Advanced life support. The author has an hindex of 1, co-authored 3 publications receiving 2 citations.

10 Systematic review of the effectiveness of prehospital critical care following out-of-hospital cardiac arrest

Abstract: Aim Improving survival after out-of-hospital cardiac arrest (OHCA) is a priority for modern emergency medical services (EMS) and prehospital research. Advanced life support (ALS) is now the standard of care in most EMS. In some EMS, prehospital critical care providers are also dispatched to attend OHCA. This systematic review presents the evidence for prehospital critical care for OHCA, when compared to standard ALS care. Method We searched the following electronic databases: PubMed, EmBASE, CINAHL Plus and AMED (via EBSCO), Cochrane Database of Systematic Reviews, DARE, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, NIHR Health Technology Assessment Database, Google Scholar and ClinicalTrials.gov. Search terms related to cardiac arrest and prehospital critical care. All studies that compared patient-centred outcomes between prehospital critical care and ALS for OHCA were included. Results The review identified six full text publications that matched the inclusion criteria, all of which are observational studies. Three studies showed no benefit from prehospital critical care but were underpowered with sample sizes of 1028 to 1851. The other three publications showed benefit from prehospital critical care delivered by physicians. However, an imbalance of prognostic factors and hospital treatment in these studies systematically favoured the prehospital critical care group. Conclusion Current evidence to support prehospital critical care for OHCA is limited by the logistic difficulties of undertaking high quality research in this area. Further research needs an appropriate sample size with adjustments for confounding factors in observational research design. Conflict of interest Johannes von Vopelius-Feldt and Jonathan Benger work as prehospital critical care physicians with the Great Western Air Ambulance. Funding This work is funded by a National Institute for Health Research (NIHR) doctoral research fellowship for Johannes von Vopelius-Feldt (DRF-2015–08–040). The funder is not involved in the design of the study or collection, analysis and interpretation of data, or in writing the manuscript. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

33 Systematic review of the effectiveness of prehospital critical care following out-of-hospital cardiac arrest

Abstract: Background Improving survival after out-of-hospital cardiac arrest (OHCA) is a priority for modern emergency medical services (EMS) and prehospital research. Advanced life support (ALS) is now the standard of care in most EMS. In some EMS, prehospital critical care providers are also dispatched to attend OHCA. This systematic review presents the evidence for prehospital critical care for OHCA, when compared to standard ALS care. Methods We searched the following electronic databases: PubMed, EmBASE, CINAHL Plus and AMED (viaEBSCO), Cochrane Database of Systematic Reviews, DARE, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, NIHR Health Technology Assessment Database, Google Scholar and ClinicalTrials.gov. Search terms related to cardiac arrest and prehospital critical care. All studies that compared patient-centred outcomes between prehospital critical care and ALS for OHCA were included. Results The review identified six full text publications that matched the inclusion criteria, all of which are observational studies. Three studies showed no benefit from prehospital critical care but were under-powered with sample sizes of 1028–1851. The other three publications showed benefit from prehospital critical care delivered by physicians. However, an imbalance of prognostic factors and hospital treatment in these studies systematically favoured the prehospital critical care group. Conclusion Current evidence to support prehospital critical care for OHCA is limited by the logistic difficulties of undertaking high quality research in this area. Further research needs an appropriate sample size with adjustments for confounding factors in observational research design.

9 The same but different – variations in stakeholders’ priorities, views on randomisation and funding of prehospital critical care for out-of-hospital cardiac arrest

Abstract: Aim Prehospital critical care for out-of-hospital cardiac arrest (OHCA) is a complex and largely unproven intervention. During research to examine this intervention, we noted significant differences in stakeholders’ views about research, randomisation and the funding of prehospital critical care for OHCA. Method We aimed to answer the following questions: What are stakeholders’ priorities for prehospital research? What are stakeholders’ views on randomisation of prehospital critical care? How do stakeholders consider allocation of resources in prehospital care? We undertook a qualitative framework analysis of interviews and focus group with five key stakeholder groups: patients and public, air ambulance charities, ambulance service commissioners, prehospital researchers and prehospital critical care providers. Results Despite sharing a common appreciation of the concepts of scientific enquiry, fairness, and beneficence, the five relevant stakeholder groups displayed divergent views of research and funding strategies regarding the intervention of prehospital critical care for the condition of OHCA. The reasons for this divergence could largely be explained through the different personal experiences and situational contexts of each stakeholder group. Many aspects of the strategies suggested by the stakeholder groups only partially aligned with principles of traditional evidence-based medicine, but were held with strong conviction. Conclusion Analysis of the views of five stakeholder groups regarding research and the funding of prehospital critical care for OHCA revealed shared values, but a variety of different strategies to achieve these. This knowledge can help researchers in similar fields in the planning and presentation of their research, to maximise impact on decision making. Conflict of interest Johannes von Vopelius-Feldt and Jonathan Benger work as prehospital physicians with the Great Western Air Ambulance. Funding This work is funded by a National Institute for Health Research (NIHR) doctoral research fellowship for Johannes von Vopelius-Feldt (DRF-2015–08–040). The funder is not involved in the design of the study or collection, analysis and interpretation of data, or in writing the manuscript. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Prehospital trauma care evolution, practice and controversies: need for a review

Abstract: Modern medicine and surgery is historically very recent, and most interventions that are so commonly done in a hospital now are only 60 to 70 years old. Understanding of emergency care of t...

Characteristics, Management, and Results of Out-of-Hospital Cardiac Arrest (OHCA) With or Without ST-Segment Elevation Myocardial Infarction (STEMI).

Abstract: Out-of-hospital cardiac arrest (OHCA) continues to be a major public health issue and leading cause of death. Cardiac arrest, also known as cardiopulmonary arrest or sudden death, is defined by the American Heart Association as the “cessation of cardiac mechanical activity, as confirmed by the absence of signs of circulation.” The etiology of cardiac arrest has been defined using the Utstein classification system, which includes 6 primary causes. The first is defined as medical, where the cause is presumed to be due to a cardiac or other medical cause. Additional primary etiologies include trauma, drug overdose, drowning, and asphyxia. The major causes of sudden cardiac death include advanced coronary artery disease and heart failure, both leading to lethal arrhythmias including but not limited to ventricular tachycardia and/or fibrillation. Sudden cardiac death in the United States has an incidence of nearly 300 000 annually and a worldwide incidence of over 4 million annually, highlighting the importance of research in this area. In the article by Arabi et al entitled “Clinical Profile, Management, and Outcome in Patients with Out of Hospital Cardiac Arrest (OHCA) and ST Segment Elevation Myocardial Infarction: Insights from a 20-year Registry,” the authors describe the survival trends including management and outcomes of patients admitted following OHCA with ST-segment elevation myocardial infarction (STEMI) or without STEMI. This is the first study that provides population-based information in the previously underrepresented middle eastern population. The data were obtained from analysis of a 20-year-registry of patients admitted to a cardiac tertiary care facility in Qatar and included 987 patients. Of those admitted following OHCA, 30% were diagnosed with a STEMI. In those diagnosed with STEMI, thrombolytic therapy was used in 38% and coronary angiography was performed in 22%. Of those undergoing angiography, 16% received percutaneous coronary intervention (PCI) during admission. The use of PCI increased significantly during the last 5 years of the study and is a likely factor in the observed decrease in the in-hospital mortality of patients with STEMI during that period of the study. The Role of Cardiac Catheterization in OHCA