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Tierarztl Prax Ausg K Kleintiere Heimtiere 2014; 42(04): 263-271
DOI: 10.1055/s-0038-1623772
Für Studium und Praxis
Schattauer GmbH

Evidenzbasierte Leitlinien zur kardiopulmonalen Reanimation bei Hund und Katze

Evidence-based guidelines for cardio-pulmonary resuscitation in the dog and cat
L. Rohwedder
1   Klinik für Kleintiere, Veterinärmedizinische Fakultät der Universität Leipzig
,
M. Alef
1   Klinik für Kleintiere, Veterinärmedizinische Fakultät der Universität Leipzig
› Author Affiliations
Further Information

Publication History

Received 18 May 2014

Accepted after resubmission 17 June 2014

Publication Date:
08 January 2018 (online)

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Zusammenfassung

Das schnelle Erkennen eines Herz-Kreislauf-Stillstandes ist entscheidend für die Überlebenschancen eines Patienten. Jeder nicht ansprechbare und nicht atmende Patient sollte als potenziell reanimationspflichtig angesehen werden. Eine Überprüfung seiner Vitalfunktionen darf nicht länger als 5–10 Sekunden dauern. Im Zweifel sollte umgehend eine qualitativ gute Thoraxkompression erfolgen (Frequenz 100–120 Kompressionen/Minute, Kompressionstiefe ein Drittel bis Hälfte des Thoraxdurchmessers, vollständige Entlastung des Thorax, keine Unterbrechung, Wechsel der durchführenden Person nach 2 Minuten). Weiterhin sollte der Patient schnellstmöglich intubiert und beatmet werden. Dabei wird eine Beatmung mit 10 Atemzügen/Minute und einem Atemzugvolumen von 10 ml/kg angestrebt. Zu den erweiterten Maßnahmen gehören die Überwachung (Elektrokardiogramm, endexspiratorische Kohlendioxidkonzentration), das Legen eines intravenösen oder intraossären Zugangs, die Gabe von 02-, Opioidund/ oder Benzodiazepin-Antagonisten sowie die herzrhythmusabhängige Therapie zur Wiederherstellung einer spontanen Zirkulation. Bei Asystolie und pulsloser elektrischer Aktivität wird Adrenalin in einer Dosierung von 0,01 mg/kg alle 3–5 Minuten appliziert (alternatives Dosierungskonzept: 0,1 mg/kg Adrenalin). Atropin kommt bei einem aufgrund eines erhöhten Vagotonus entstandenen Herz-Kreislauf-Stillstandes und Bradykardie zur Anwendung (0,04 mg/kg alle 3–5 Minuten). Bei Kammerflimmern und pulsloser ventrikulärer Tachykardie stellt eine Defibrillation das Mittel der Wahl dar. Besteht dazu keine Möglichkeit, ist die Gabe von Amiodaron (5 mg/kg) oder Lidocain (2 mg/kg) indiziert. Während der Reanimation wird eine inspiratorische Sauerstoffkonzentration von 100% empfohlen, nicht jedoch die routinemäßige Verabreichung einer Infusion. Nach der Rückkehr der spontanen Zirkulation ist eine Intensivtherapie erforderlich. Sie umfasst neben einer intensiven Überwachung die Optimierung der hämodynamischen Situation durch Infusionstherapie, Vasopressoren und inotropen Arzneimitteln sowie die Normalisierung des pulmonalen Gasaustausches und die Neuroprotektion.

Summary

Early recognition of a cardio-pulmonary arrest (CPA) is crucial for patient survival. Every non-breathing and non-responsive patient should be considered to have CPA, and examination of the vital signs should last no longer than 5–10 seconds. If in doubt, effective chest compressions should be started immediately (frequency of 100–120 compressions per minute, compression depth one third to half of the chest diameter, full chest wall recoil between the compressions, no interruption, change of compressing person every 2 minutes). Furthermore, the patient should be intubated and ventilated as early as possible with a frequency of 10 breaths per minute and a volume of 10 ml/kg. Additional measures include monitoring (electrocardiogram, end-expiratory carbon dioxide concentration), placement of an intravenous or intraosseous catheter, administration of opioid-, benzodiazepineand/or 02-antagonists and ECG-dependent therapy to restore spontaneous circulation. In the case of asystole and pulseless electric activity, epinephrine (0.01 mg/kg every 3–5 minutes, alternative dose concept: 0.1 mg/kg epinephrine) is advised. In the case of CPA due to elevated vagal tonus or bradycardia, atropine should be given (0.04 mg/kg every 3–5 minutes). If ventricular fibrillation or pulseless ventricular tachyarrhythmia is present, defibrillation is the therapy of choice. When this is not possible, amiodarone (5 mg/kg) or lidocaine (2 mg/kg) should be administered. Furthermore, 100% oxygen should be given during resuscitation, while only a few patients benefit from infusion therapy. Following the return of spontaneous circulation, intensive care of the patient is necessary. This involves intense monitoring and support of the haemodynamic situation using intravenous fluids, vasopressors and positive inotropic drugs as well as an improvement of gas exchange and neuroprotection.

Schlüsselwörter

Herz-Kreislauf-Stillstand - Wiederbelebung - Notfall - Thoraxkompression - Adrenalin

Key words

Cardio-pulmonary arrest - resuscitation - emergency - thorax compression - adrenaline
 

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