Gerrit Jansen

Background: This study evaluated the effects of the new supraglottic airway device known as laryngeal tube evo on target parameters of ventilation therapy during mechanical chest compressions in intra-arrest ventilation with bag-valve-device ventilation vs. volume-controlled ventilation. Methods: Thiel-embalmed human body donors were included in a standardized resuscitation scenario. Ventilation was performed in a randomized order using the laryngeal tube evo for bag-valve-device ventilation and volume-controlled ventilation during mechanical cardiopulmonary resuscitation. Expiratory (Vt _e ) and expiratory tidal volumes per kg body weight (Vt _e /kgBW); delta tidal volume (difference between ideal and expiratory tidal volume; ΔVt); leakage volume ( V _leak ); peak ( P _peak ); mean ( P _mean ) and plateau ( P _plat ) pressures and respiratory rates were recorded. The primary efficacy endpoint was Vt _e . Results: Five body donors were included. Although one donor (20%) was successfully ventilated with all ventilation modes, three could only be ventilated with one of the modes (bag-valve-device ventilation = 20%; volume-controlled ventilation = 40%). One donor (20%) could not be sufficiently ventilated with any of the modes. Mean Vt _e was 91.73 ± 66.3 ml with bag-valve-device ventilation versus 142.93 ± 115.05 ml with volume-controlled ventilation. The comparison of both ventilation modes revealed higher Vt _e (50.27 ml; 95% confidence interval (CI): 7.56 to 92.97; p = 0.02), Vt _e /kgBW (0.8 ml; 95% CI: 0.05 to 1.56; p = 0.04), P _mean (5.23 mbar; 95% CI: 4 to 6.47; p < 0.0001) and P _plat (10.36 mbar; 95% CI: 8.08 to 12.64; p < 0.0001), but lower ∆Vt (− 50.3 ml; 95% CI: − 93 to − 7.59; p = 0.02) and respiratory rates (− 10.83/min; 95% CI: − 17.29 to − 4.36; p = 0.001) for volume-controlled ventilation. Conclusions: Comparing volume-controlled ventilation with bag-valve-device ventilation for asynchronous ventilation during mechanical cardiopulmonary resuscitation using the laryngeal tube evo, volume-controlled ventilation resulted in higher Vt _e and Vt _e /kgBW, but lower ∆Vt and respiratory rates. Future studies should evaluate laryngeal tube evo in prehospital use during mechanical cardiopulmonary resuscitation. When doubts regarding its effectiveness are present, synchronous ventilation (30:2) should be performed. Trial registration: German Clinical Trials Register; unique identifier: DRKS00037836. Registered on September 09, 2025 [1].

Background: Ammonia inhalation can cause rapid airway compromise and noncardiogenic pulmonary oedema. Although hospital management has been described, prehospital strategies in severe cases remain largely undocumented. Case presentation: A 44-year-old obese male (160 kg) was exposed to an ammonia cloud at a decommissioned power plant. He presented with mucosal burns, severe dyspnoea, and hypoxemia despite high-flow oxygen. Prehospital providers initiated nebulized adrenaline, performed ocular irrigation, and prepared for surgical airway backup. Rapid sequence intubation was conducted under video laryngoscopy. Immediately post-intubation, copious foamy secretions confirmed fulminant pulmonary oedema. Despite FiO₂ 1.0 and a PEEP of 12 cmH₂O, oxygenation remained marginal at 89–90%. Intravenous corticosteroids were administered, burns were covered, and the patient was transported by helicopter to a burn and critical care centre. On-scene decontamination was deferred due to instability; the EMS team underwent full decontamination after patient handover. Ground transport to the nearest regional centre would have required approximately 60 min; HEMS transport directly to the tertiary burn centre (MHH Hannover) took approximately 35 min. Beyond transport time, HEMS use involved inherent aeromedical risks: residual ammonia off gassing in the confined cockpit and cabin posed a risk of mucosal irritation or pilot incapacitation, and inadvertent chemical contamination of sensitive avionics or airframe components posed a corrosion risk. These were weighed against clinical urgency and the absence of adequate regional ICU or burn capacity. No formal risk-based framework currently exists to guide HEMS transport of CBRN-exposed patients; this case underscores the need for one. Conclusions: This case demonstrates the unique prehospital challenges of ammonia inhalation: the need for early definitive airway management, refractory hypoxemia beyond the capacity of prehospital ventilators, and operational dilemmas such as delayed decontamination, patient weight, and limited local ICU resources. It highlights the urgent need for structured EMS protocols for caustic inhalation events. Beyond the clinical case, this report addresses the complexity of transport decision-making in critically ill patients with incomplete decontamination, including civil aviation safety considerations and the absence of a risk-based framework for CBRN aeromedical transport.

Background: This study evaluates the effects of the new supraglottic airway-device laryngeal tube evo (LT ^® evo) versus that of tracheal intubation (TI) concerning the target parameters of ventilation therapy during mechanical chest compressions in intra-arrest-ventilation with biphasic-positive-airway-pressure-ventilation. Methods: This prospective randomized crossover study involving Thiel-embalmed human body donors, compares TI with LT ^® evo using biphasic-positive-airway-pressure-ventilation during mechanical cardiopulmonary resuscitation. Each body donor underwent ventilation with both airway-devices in randomized order. Ventilatory parameters were recorded at ventilator flow sensors. Primary endpoint was expiratory tidal volume (VT _e ), secondary endpoints included expiratory tidal volume per kg ideal body weight (VT _e /kgIBW); delta tidal volume (ideal-VT _e ; ΔVT); leakage volume (V _Leak ); peak (P _Peak ), mean (P _Mean ), plateau (P _Plat ) pressures; and respiratory rates. Results: Five body donors were included. Linear regression analyses with random intercepts revealed lower VT _e (-295.7 ± 8 ml; 95%CI:-339.2 to -252.2); p < 0.0001), VT _e /kgIBW (-5.0 ml/kg; 95%:-5.7 to -4.2; p < 0.0001), P _Peak (-19.0mbar; 95%CI:-23.1 to -14.9; p < 0.0001) and P _Mean (-2mbar; 95%CI:-3.2 to -0.8 ; p = 0.001) but higher ∆VT (296.0 ml; 95%CI:252.5 to 339.4; p < 0.0001) and V _Leak (52.7%; 95%CI:41.6 to 63.7; p < 0.0001) for LT ^® evo. While all tracheal-intubated body donors (100%) were successfully ventilated with biphasic-positive-airway-pressure-ventilation (VT _e /kgIBW > 2 ml/kg), only one of five body donors (20%) could be ventilated via LT ^® evo. Conclusion: In this body donor model of biphasic-positive-airway-pressure-ventilation during mechanical cardiopulmonary resuscitation, TI provided higher VT _e and lower leakage than LT ^® evo did. LT ^® evo ventilation frequently failed to achieve tidal volumes above the estimated dead space. These findings suggest that LT ^® evo may be poorly suited for intra-arrest ventilation using biphasic-positive-airway-pressure-ventilation during mechanical cardiopulmonary resuscitation. When the LT ^® evo is used in this setting, a synchronous 30:2 ventilation strategy may represent a safer alternative. Trial registration: German Clinical Trials Register; unique identifier: DRKS00037836; registration date: September 09, 2025.

Background: Out-of-hospital cardiac arrest (OHCA) remains a major cause of mortality, with low survival probabilities to hospital discharge. Despite the frequent use of airway management and mechanical ventilation during resuscitation, there is limited evidence regarding the optimal ventilation strategy to improve oxygen delivery and patient outcomes. The present study aims to investigate the effects of positive-end-expiratory-pressure (PEEP) set at 5 mbar compared to zero-end-expiratory-pressure (ZEEP) on the return of spontaneous-circulation (ROSC) in adult patients with OHCA. Methods: This is a prospective, multicenter, cluster-randomized controlled trial conducted across emergency medical services (EMS) in the regions of Gütersloh, Minden-Lübbecke, and Osnabrück. Adult patients (≥ 18 years) with OHCA who are undergoing mechanical ventilation through an airway device will be enrolled. The clusters (regional districts) will be randomized into two groups: one group will receive ventilation with PEEP set at 5 mbar (intervention group), while the other group will receive ventilation with ZEEP (control group). The study’s primary endpoint is the occurence of ROSC. Secondary endpoints include occurence of re-arrest, death during pre-hospital care phase, hospital admission during ongoing resuscitation, hospital admission with spontaneous circulation, peripheral oxygen saturation, and endtidal CO ₂ at hospital admission. Discussion: Optimal ventilation strategies during OHCA have not been well established. The use of PEEP may improve oxygenation and oxygen delivery. This study aims to provide crucial data on whether the application of PEEP at 5 mbar vs. 0 mbar can improve the probability of ROSC without adversely affecting hemodynamics. The findings could inform future guidelines on ventilation strategies in resuscitation. Trial registration: The trial is registered on ClinicalTrials.gov under the registration number NCT06836830. 24.02.2025 https://clinicaltrials.gov/study/NCT06836830?term=gerrit%20jansen&rank=2 .

Background: Out-of-hospital cardiac arrest remains a major challenge due to its high incidence and low survival rates. In recent decades, research has focused on the performance of chest compressions and improvements in early defibrillation, while the optimal ventilation strategy remains unclear. Despite the lack of monitoring systems, manual bag-valve-device ventilation is still common. Given the potential impact of both the applied volumes and the ventilation pressures on hemodynamics and resuscitation efforts, the present study investigated the effects of various airway devices on the target parameters of ventilation therapy during manual intra-arrest ventilation. Methods: Thiel-embalmed human cadavers were included in a standardized resuscitation scenario. Ventilation was performed in a randomized order using various airway devices (tracheal tube (ET), supraglottic airway devices (SGA): laryngeal mask airway, laryngeal tube, i-gel ^® laryngeal mask) and manual bag-valve-device ventilation. Chest compressions were performed via Corpuls-CPR. Ideal (Vt _ideal ), expiratory (Vt _e ) and inspiratory (Vt _i ) tidal volumes; leakage volume (V _leak ); and peak (P _peak ) and mean (P _mean ) pressures were recorded. The primary efficacy endpoint was the difference between Vt _ideal and Vt _e (∆Vt). Results: Eleven cadavers were included (mean age at the time of death: 84 ± 3.7 years, male = 7 [63.6%]). During ventilation with ET, the following mean values were measured: ΔVt, 142.2 ± 125.5 ml; Vt _e, 245.1 ± 91.2 ml; V _leak, 17.9 ± 15.3%; P _mean, 4.0 ± 1.5 mbar; and P _peak, 47.7 ± 14.9 mbar. During ventilation with SGA, however, the mean values were ΔVt, 202.0 ± 153.1 ml; Vt _e, 183.8 ± 122.1 ml; V _leak, 39.0 ± 23.5%; P _mean, 3.1 ± 1.0 mbar; and P _peak, 39.0 ± 10.0 mbar. Comparison of the two groups revealed lower ΔVt values (regression coefficient [RC] = –61.07 ml, 95% confidence interval [95% CI] = [–93.58;–28.55], p = 0.0003) and V _leak values (RC = –20.98%, 95% CI = [–26.63;–15.33], pe values (RC = 61.14 ml, 95% CI = [28.63;93.65], p = 0.0003), P _mean values (RC = 0.90 mbar, 95% CI = [0.59;1.21], ppeak values (RC = 11.46 mbar, 95% CI = [8.65;14.26], p<0.0001) in the ET group. There was no evidence for differences in ΔVt among the cadavers in the SGA group. Conclusion: The ∆Vt was lower in the ET group than the SGA group, whereas there was no evidence for differences in ∆Vt among the devices in the SGA group. Trial registration: clinicaltrials.gov; Unique identifier: NCT06306898, Registration date: 5 March 2024.

Background: In this retrospective observational study, we compared the efficacy and safety of paracetamol compared with those of nalbuphine plus paracetamol and piritramide in prehospital analgesia for trauma-related pain administered by paramedics. Methods: All prehospital analgesia for trauma-related pain administered by paramedics in the emergency medical services of the districts of Fulda (piritramide) and Guetersloh (paracetamol, nalbuphine plus paracetamol) was analyzed based on electronic medical records. Primary endpoint was effective analgesia defined as a numeric rating scale (NRS) score ≤ 4 at hospital admission. Safety was evaluated based on the occurrence of drug-related complications (nausea/vomiting, antiemetic use, reduced level of consciousness, respiratory or hemodynamic insufficiency). Results: A total of 1,295 interventions (district of Guetersloh: n = 784 [60.5%], district of Fulda: n = 511 [39.5%]) were analyzed. Paracetamol: n = 291 [22.5%], initial NRS: 6.8 ± 1.4, final NRS: 4.0 ± 1.9. Nalbuphine plus paracetamol: n = 493 [38.1%], initial NRS: 8.2 ± 1.3, final NRS: 3.6 ± 1.9. Piritramide: n = 511 [39.5%], initial NRS: 8.3 ± 1.1, final NRS: 4.3 ± 1.5. The likelihood of achieving NRS ≤ 4 at hospital admission was highest in the nalbuphine plus paracetamol group (odds ratio (OR): 3.25, 95% confidence interval (95% CI): 2.46–4.30) and lower in the piritramide (OR: 0.31, 95% CI: 0.23–0.41) and paracetamol (OR: 0.32, 95% CI: 0.23–0.45) groups. The comparison between piritramide ( n = 30 [5.9%]) and nalbuphine plus paracetamol ( n = 34 [7.7%]) did not reveal evidence for differences in the occurrence of drug-related complications (OR: 0.75, 95% CI: 0.45–1.24). Conclusions: Analgesia with nalbuphine plus paracetamol for trauma patients administered by paramedics were more effective in reducing pain to NRS ≤ 4 at hospital admission compared to monotherapy with paracetamol or piritramide, with a comparable safety profile.

Background: Out-of-hospital cardiac arrest (OHCA) remains a major cause of mortality, with low survival probabilities to hospital discharge. Despite the frequent use of airway management and mechanical ventilation during resuscitation, there is limited evidence regarding the optimal ventilation strategy to improve oxygen delivery and patient outcomes. The present study aims to investigate the effects of positive-end-expiratory-pressure (PEEP) set at 5mbar compared to zero-end-expiratory-pressure (ZEEP) on the return of spontaneous-circulation (ROSC) in adult patients with OHCA. Methods: This is a prospective, multicenter, cluster-randomized controlled trial conducted across emergency medical services (EMS) in the regions of Gütersloh, Minden-Lübbecke, and Osnabrück. Adult patients (≥18 years) with OHCA who are undergoing mechanical ventilation through an airway device will be enrolled. The clusters (regional districts) will be randomized into two groups: one group will receive ventilation with PEEP set at 5 mbar (intervention group), while the other group will receive ventilation with ZEEP (control group). The study's primary endpoint is the rate of ROSC. Secondary endpoints include rate of re-arrest, death during pre-hospital care phase, hospital admission during ongoing resuscitation, hospital admission with spontaneous circulation, peripheral oxygen saturation and endtidal CO2 at hospital admission. Discussion: Optimal ventilation strategies during OHCA have not been well established. The use of PEEP may improve oxygenation and oxygen delivery. This study aims to provide crucial data on whether the application of PEEP at 5 mbar vs. 0 mbar can improve the probability of ROSC without adversely affecting hemodynamics. The findings could inform future guidelines on ventilation strategies in resuscitation. Trial registration: The trial is registered on ClinicalTrials.gov under the registration number NCT06836830. 24.02.2025 https://clinicaltrials.gov/study/NCT06836830?term=gerrit%20jansen&rank=2