Außerklinische Reanimation: Wo stehen wir heute?

Bei einem Kreislaufstillstand sind die ersten Minuten und Stunden entscheidend – eine rasche und adäquate Versorgung kann die Überlebenschancen deutlich steigern. Sowohl der Rettungsdienst als auch die annehmende Klinik werden hier vor große Herausforderungen gestellt. Dieser Beitrag soll die wichtigsten Schritte während und nach einer Reanimation illustrieren und auf Neuerungen eingehen.

Abstract

In circulatory arrest, the first minutes and hours are crucial - rapid and adequate care can significantly increase the chances of survival. A large number of disciplines are involved in the recommendations and guidelines for out-of-hospital resuscitation. In particular, the European Resuscitation Council (ERC) as well as the European Society of Cardiology (ESC) and the American Heart Association (AHA) are leading the way. Both the ambulance service and the accepting hospital are faced with major challenges in this regard. This article will illustrate the most important steps during and after resuscitation and discuss innovations.

Schlüsselwörter

Kreislaufstillstand - Laienreanimation - BLS - ALS - ROSC - Transport - CART

Keywords

circulatory arrest - basic life support - BLS - ALS - ROSC - transport - CART

• Literatur

• 1 Fischer M, Wnent J, Gräsner JT. et al. Öffentlicher Jahresbericht 2019 des Deutschen Reanimationsregisters: Außerklinische Reanimation 2019. Accessed February 20, 2022 at: https://www.reanimationsregister.de/downloads/oeffentliche-jahresberichte/rettungsdienst/168-oeffentlicher-jahresbericht-2019/file.html
• 2 Gräsner JT, Herlitz J, Tjelmeland IBM. et al. European Resuscitation Council Guidelines 2021: Epidemiology of cardiac arrest in Europe. Resuscitation 2021; 161: 61-79
• 3 Gräsner JT, Wnent J, Herlitz J. et al. Survival after out-of-hospital cardiac arrest in Europe – Results of the EuReCa TWO study. Resuscitation 2020; 148: 218-226
• 4 Adnet F, Triba MN, Borron SW. et al. Cardiopulmonary resuscitation duration and survival in out-of-hospital cardiac arrest patients. Resuscitation 2017; 111: 74-81
• 5 Olasveengen TM, Semeraro F, Ristagno G. et al. European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation 2021; 161: 98-114
• 6 Schwarzkoph M, Yin L, Hergert L. et al. Seizure-like presentation in OHCA creates barriers to dispatch recognition of cardiac arrest. Resuscitation 2020; 156: 230-236
• 7 Panchal AR, Bartos JA, Cabañas JG. et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142(16_suppl_2): S366-S468
• 8 Berg KM, Cheng A, Panchal AR. et al. Part 7: Systems of Care: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142(16_suppl_2): S580-S604
• 9 Soar J, Böttiger BW, Carli P. et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation 2021; 161: 115-151
• 10 Okubo M, Komukai S, Callaway CW. et al. Association of Timing of Epinephrine Administration With Outcomes in Adults With Out-of-Hospital Cardiac Arrest. JAMA Netw Open 2021; 4: e2120176
• 11 Fandler M, Gotthardt P. SOP Prähospitale Notfallsonografie. Notfallmedizin up2date 2018; 13: 10-12
• 12 Aagaard R, Caap P, Hansson NC. et al. Detection of Pulmonary Embolism During Cardiac Arrest-Ultrasonographic Findings Should Be Interpreted With Caution. Crit Care Med 2017; 45: e695-e702
• 13 Scholz KH, Maier SKG, Maier LS. et al. Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial. Eur Heart J 2018; 39: 1065-1074
• 14 Scholz KH, Andresen D, Böttiger BW. et al. Qualitätsindikatoren und strukturelle Voraussetzungen für Cardiac-Arrest-Zentren – Deutscher Rat für Wiederbelebung/German Resuscitation Council (GRC). Kardiologe 2017; 11: 205-208
• 15 Kelham M, Jones TN, Rathod KS. et al. An observational study assessing the impact of a cardiac arrest centre on patient outcomes after out-of-hospital cardiac arrest (OHCA). Eur Heart J Acute Cardiovasc Care 2020; 9(4_suppl): S67-S73
• 16 Nolan JP, Sandroni C, Böttiger BW. et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care. Resuscitation 2021; 161: 220-269
• 17 Zhu N, Chen Q, Jiang Z. et al. A meta-analysis of the resuscitative effects of mechanical and manual chest compression in out-of-hospital cardiac arrest patients. Crit Care 2019; 23: 100
• 18 Bartos JA, Frascone RJ, Conterato M. et al. The Minnesota mobile extracorporeal cardiopulmonary resuscitation consortium for treatment of out-of-hospital refractory ventricular fibrillation: Program description, performance, and outcomes. EClinicalMedicine 2020; 29–30: 100632
• 19 Michels G, Wengenmayer T, Hagl C. et al. Recommendations for extracorporeal cardiopulmonary resuscitation (eCPR): consensus statement of DGIIN, DGK, DGTHG, DGfK, DGNI, DGAI, DIVI and GRC. Clin Res Cardiol 2019; 108: 455-464
• 20 Busch HJ, Schmid B, Kron J. et al. Freiburg Cardiac Arrest Receiving Team (CART): Interdisciplinary solution for the acute management of non-traumatic out-of-hospital cardiac arrest. Med Klin Intensivmed Notfallmed 2020; 115: 292-299
• 21 Soar J, Nolan JP, Böttiger BW. et al. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95: 100-147
• 22 Dankiewicz J, Cronberg T, Lilja G. et al. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. N Engl J Med 2021; 384: 2283-2294
• 23 Thomsen JH, Hassager C, Bro-Jeppesen J. et al. Sinus bradycardia during hypothermia in comatose survivors of out-of-hospital cardiac arrest – A new early marker of favorable outcome?. Resuscitation 2015; 89: 36-42