Download PDF
NOTARZT 2015; 31(06): 306-315
DOI: 10.1055/s-0041-108482
CME – Fort- und Weiterbildung
© Georg Thieme Verlag KG Stuttgart · New York

Leitliniennovelle 2015 – Was gibt es Neues bei der Reanimation von Erwachsenen?

Resuscitation guidelines 2015 – Is there something new in adult resuscitation?
M.- M. Ventzke
1   Bundeswehrkrankenhaus Ulm, Klinik für Anästhesie und Intensivmedizin, Ulm
2   Kreiskliniken Günzburg-Krumbach, Klinik Günzburg
,
G. Kemming
2   Kreiskliniken Günzburg-Krumbach, Klinik Günzburg
› Author Affiliations
Further Information

Publication History

Publication Date:
18 December 2015 (online)

Also available at
    Permissions and Reprints
Kernaussagen

Entscheidend für die Prognose nach Herzstillstand ist die zeitige, unterbrechungsfreie und gut ausgeführte Basisreanimation. Dies schlägt sich auch in den Leitlinien nieder. Während in den Leitlinien und Ausbildungsbemühungen vorangegangener Jahre technische und medikamentöse Maßnahmen im Fokus standen, sind es heute die Basismaßnahmen. Prognosebestimmend für den Patienten sind einfache aber wichtige Aktionen wie

  • das frühe Erkennen eines Kreislaufstillstands,

  • die telefonische Anleitung zur Wiederbelebung durch den Leitstellendisponenten,

  • die suffiziente Basisreanimation durch den Laienhelfer und

  • die frühe Defibrillation.

Die Basisreanimation wird in der bisherigen Form beibehalten:

  • 30 Thoraxkompressionen : 2 Beatmungen

  • Beatmung mit 500–600 ml, die eine sichtbare Thoraxexkursion hervorruft.

  • Kompression mit einer Frequenz von 100–120/min und einer Drucktiefe von 5–6 cm, die so wenig wie möglich unterbrochen werden sollte.

  • Defibrillation, sofern erforderlich, sobald wie möglich, dann alle 5 Zyklen

Diese überaus wichtigen Basismaßnahmen werden durch erweiterte Maßnahmen ergänzt, wobei sich das Vorgehen seit 2010 nicht geändert hat. Der Stellenwert der Postreanimationsbehandlung nimmt zu, daher ist diesem Thema und dem eigenständigen Krankheitsbild des Postreanimationssyndroms ein eigenes Kapitel in den Leitlinien gewidmet. Zudem gehen die Leitlinien auf die CPR in besonderen Situationen mit eigenen Algorithmen ein, wie z. B. für Anaphylaxie, Lawinenunfall oder traumatisch bedingter Kreislaufstillstand.

 

  • Literatur

  • 1 Figl M, Pelinka LE, Mauritz W. Resuscitation great. Franz Koenig and Friedrich Maass. Resuscitation 2006; 70: 6-9
    CrossrefPubMedGoogle Scholar
  • 2 Woods RH. On artificial respiration. Trans R Acad Med Ir 1906; 24: 136-141
    PubMedGoogle Scholar
  • 3 Baskett PJ, Peter J. Safar. Part two. The University of Pittsburgh to the Safar Centre for Resuscitation Research 1961–2002. Resuscitation 2002; 55: 3-7
    CrossrefPubMedGoogle Scholar
  • 4 Cohen SI. Resuscitation great. Paul M. Zoll, M.D. – the father of „modern“ electrotherapy and innovator of pharmacotherapy for life-threatening cardiac arrhythmias. Resuscitation 2007; 73: 178-183
    CrossrefPubMedGoogle Scholar
  • 5 Ussenko LV, Tsarev V, Leschenko YA. Resuscitation great. Naum L Gurvich: a pioneer of defibrillation. Resuscitation 2006; 70: 170-172
    CrossrefPubMedGoogle Scholar
  • 6 Cooper JA, Cooper JD, Cooper JM. Cardiopulmonary resuscitation: history, current practice, and future direction. Circulation 2006; 114: 2839-2849
    CrossrefPubMedGoogle Scholar
  • 7 Eisenberg MS, Psaty BM. Cardiopulmonary resuscitation: celebration and challenges. JAMA 2010; 304: 87-88
    CrossrefPubMedGoogle Scholar
  • 8 Nolan JP, Soar J, Cariou A et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95: 202-222
    CrossrefPubMedGoogle Scholar
  • 9 Morley PT, Lang E, Aickin R et al. Part 2: Evidence evaluation and management of conflicts of interest: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2015; 95: e33-e41
    CrossrefPubMedGoogle Scholar
  • 10 Nolan JP, Hazinski MF, Aickin R et al. Part 1: Executive summary: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2015; 95: e1-e31
    CrossrefPubMedGoogle Scholar
  • 11 Perkins GD, Travers AH, Berg RA et al. Part 3: Adult basic life support and automated external defibrillation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2015; 95: e43-e69
    CrossrefPubMedGoogle Scholar
  • 12 Soar J, Callaway CW, Aibiki M et al. Part 4: Advanced life support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2015; 95: e71-e120
    CrossrefPubMedGoogle Scholar
  • 13 Nikolaou NI, Welsford M, Beygui F et al. Part 5: Acute coronary syndromes: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2015; 95: e121-146
    CrossrefPubMedGoogle Scholar
  • 14 Maconochie IK, de Caen AR, Aickin R et al. Part 6: Pediatric basic life support and pediatric advanced life support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2015; 95: e147-e168
    CrossrefPubMedGoogle Scholar
  • 15 Wyllie J, Perlman JM, Kattwinkel J et al. Part 7: Neonatal resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2015; 95: e169-e201
    CrossrefPubMedGoogle Scholar
  • 16 Finn JC, Bhanji F, Lockey A et al. Part 8: Education, implementation, and teams: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2015; 95: e203-e224
    CrossrefPubMedGoogle Scholar
  • 17 Zideman DA, Singletary EM, De Buck ED et al. Part 9: First aid: 2015 International Consensus on First Aid Science with Treatment Recommendations. Resuscitation 2015; 95: e225-e261
    CrossrefPubMedGoogle Scholar
  • 18 Nikolaou NI, Arntz HR, Bellou A et al. European Resuscitation Council Guidelines for Resuscitation 2015 Section 8. Initial management of acute coronary syndromes. Resuscitation 2015; 95: 264-277
    CrossrefPubMedGoogle Scholar
  • 19 Zideman DA, De Buck ED, Singletary EM et al. European Resuscitation Council Guidelines for Resuscitation 2015 Section 9. First aid. Resuscitation 2015; 95: 278–287 20 Monsieurs KG, Nolan JP, Bossaert LL et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015; 95: 278-287
    CrossrefPubMedGoogle Scholar
  • 20 Monsieurs KG, Nolan JP, Bossaert LL et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015; 95: 1-80
    CrossrefPubMedGoogle Scholar
  • 21 Perkins GD, Handley AJ, Koster RW et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation 2015; 95: 81-99
    CrossrefPubMedGoogle Scholar
  • 22 Soar J, Nolan JP, Bottiger BW et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2015; 95: 100-147
    CrossrefPubMedGoogle Scholar
  • 23 Truhlar A, Deakin CD, Soar J et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95: 148-201
    CrossrefPubMedGoogle Scholar
  • 24 Maconochie IK, Bingham R, Eich C et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 6. Paediatric life support. Resuscitation 2015; 95: 223-248
    CrossrefPubMedGoogle Scholar
  • 25 Wyllie J, Bruinenberg J, Roehr CC et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 7. Resuscitation and support of transition of babies at birth. Resuscitation 2015; 95: 249-263
    CrossrefPubMedGoogle Scholar
  • 26 Greif R, Lockey AS, Conaghan P et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 10. Education and implementation of resuscitation. Resuscitation 2015; 95: 288-301
    CrossrefPubMedGoogle Scholar
  • 27 Bossaert LL, Perkins GD, Askitopoulou H et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 11. The ethics of resuscitation and end-of-life decisions. Resuscitation 2015; 95: 302-311
    CrossrefPubMedGoogle Scholar
  • 28 Babbs CF, Kern KB. Optimum compression to ventilation ratios in CPR under realistic, practical conditions: a physiological and mathematical analysis. Resuscitation 2002; 54: 147-157
    CrossrefPubMedGoogle Scholar
  • 29 Fenici P, Idris AH, Lurie KG et al. What is the optimal chest compression-ventilation ratio?. Curr Opin Crit Care 2005; 11: 204-211
    CrossrefPubMedGoogle Scholar
  • 30 Wayne MA, Levine RL, Miller CC. Use of end-tidal carbon dioxide to predict outcome in prehospital cardiac arrest. Ann Emerg Med 1995; 25: 762-767
    CrossrefPubMedGoogle Scholar
  • 31 Ahrens T, Schallom L, Bettorf K et al. End-tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest. Am J Crit Care 2001; 10: 391-398
    PubMedGoogle Scholar
  • 32 Callaham M, Barton C. Prediction of outcome of cardiopulmonary resuscitation from end-tidal carbon dioxide concentration. Crit Care Med 1990; 18: 358-362
    CrossrefPubMedGoogle Scholar
  • 33 Cantineau JP, Lambert Y, Merckx P et al. End-tidal carbon dioxide during cardiopulmonary resuscitation in humans presenting mostly with asystole: a predictor of outcome. Crit Care Med 1996; 24: 791-796
    CrossrefPubMedGoogle Scholar
  • 34 Levine RL, Wayne MA, Miller CC. End-tidal carbon dioxide and outcome of out-ofhospital cardiac arrest. N Engl J Med 1997; 337: 301-306
    CrossrefPubMedGoogle Scholar
  • 35 Hellevuo H, Sainio M, Nevalainen R et al. Deeper chest compression - more complications for cardiac arrest patients?. Resuscitation 2013; 84: 760-765
    CrossrefPubMedGoogle Scholar
  • 36 Sunde K, Eftestol T, Askenberg C et al. Quality assessment of defribrillation and advanced life support using data from the medical control module of the defibrillator. Resuscitation 1999; 41: 232-247
    PubMedGoogle Scholar
  • 37 Tang W, Weil MH, Sun S et al. The effects of biphasic and conventional monophasic defibrillation on postresuscitation myocardial function. J Am Coll Cardiol 1999; 34: 815-822
    CrossrefPubMedGoogle Scholar
  • 38 Wik L, Olsen JA, Persse D et al. Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial. Resuscitation 2014; 85: 741-748
    CrossrefPubMedGoogle Scholar
  • 39 Rubertsson S, Lindgren E, Smekal D et al. Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in outof-hospital cardiac arrest: the LINC randomized trial. JAMA 2014; 311: 53-61
    CrossrefPubMedGoogle Scholar
  • 40 Perkins GD, Lall R, Quinn T et al. Mechanical versus manual chest compression for out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised controlled trial. Lancet 2015; 385: 947-955
    CrossrefPubMedGoogle Scholar
  • 41 Hostler D, Everson-Stewart S, Rea TD et al. Effect of real-time feedback during cardiopulmonary resuscitation outside hospital: prospective, cluster-randomised trial. BMJ 2011; 342: d512
    CrossrefPubMedGoogle Scholar
  • 42 Bohn A, Weber TP, Wecker S et al. The addition of voice prompts to audiovisual feedback and debriefing does not modify CPR quality or outcomes in out of hospital cardiac arrest--a prospective, randomized trial. Resuscitation 2011; 82: 257-262
    CrossrefPubMedGoogle Scholar
  • 43 Cheskes S, Schmicker RH, Christensen J et al. Perishock pause: an independent predictor of survival from out-of-hospital shockable cardiac arrest. Circulation 2011; 124: 58-66
    CrossrefPubMedGoogle Scholar
  • 44 Gundersen K, Kvaloy JT, Kramer-Johansen J et al. Development of the probability of return of spontaneous circulation in intervals without chest compressions during out-of-hospital cardiac arrest: an observational study. BMC Med 2009; 7: 6
    CrossrefPubMedGoogle Scholar
  • 45 Sell RE, Sarno R, Lawrence B et al. Minimizing pre- and post-defibrillation pauses increases the likelihood of return of spontaneous circulation (ROSC). Resuscitation 2010; 81: 822-825
    CrossrefPubMedGoogle Scholar
  • 46 Cheskes S, Schmicker RH, Verbeek PR et al. The impact of peri-shock pause on survival from out-of-hospital shockable cardiac arrest during the Resuscitation Outcomes Consortium PRIMED trial. Resuscitation 2014; 85: 336-342
    CrossrefPubMedGoogle Scholar
  • 47 Edelson DP, Abella BS, Kramer-Johansen J et al. Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. Resuscitation 2006; 71: 137-145
    CrossrefPubMedGoogle Scholar
  • 48 Eftestol T, Sunde K, Steen PA. Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest. Circulation 2002; 105: 2270-2273
    CrossrefPubMedGoogle Scholar
  • 49 Olsen JA, Brunborg C, Steinberg M et al. Pre-shock chest compression pause effects on termination of ventricular fibrillation / tachycardia and return of organized rhythm within mechanical and manual cardiopulmonary resuscitation. Resuscitation 2015; 93: 158-163
    CrossrefPubMedGoogle Scholar
  • 50 Zwingmann J, Mehlhorn AT, Hammer T et al. Survival and neurologic outcome after traumatic out-of-hospital cardiopulmonary arrest in a pediatric and adult population: a systematic review. Crit Care 2012; 16: R117
    CrossrefPubMedGoogle Scholar
  • 51 Leis CC, Hernandez CC, Blanco MJ et al. Traumatic cardiac arrest: should advanced life support be initiated?. J Trauma Acute Care Surg 2013; 74: 634-638
    CrossrefPubMedGoogle Scholar
  • 52 Racz E, Konczol F, Meszaros H et al. Drowning-related fatalities during a 5-year period (2008–2012) in South-West Hungary – A retrospective study. J Forensic Leg Med 2015; 31: 7-11
    CrossrefPubMedGoogle Scholar
  • 53 Halik R, Poznanska A, Seroka W et al. Accidental drownings in Poland in 2000–2012. Przegl Epidemiol 2014; 68: 493-499 , 591–494
    PubMedGoogle Scholar
  • 54 Schneider AG, Eastwood GM, Bellomo R et al. Arterial carbon dioxide tension and outcome in patients admitted to the intensive care unit after cardiac arrest. Resuscitation 2013; 84: 927-934
    CrossrefPubMedGoogle Scholar
  • 55 Vaahersalo J, Bendel S, Reinikainen M et al. Arterial blood gas tensions after resuscitation from out-of-hospital cardiac arrest: associations with long-term neurologic outcome. Crit Care Med 2014; 42: 1463-1470
    CrossrefPubMedGoogle Scholar
  • 56 Kim F, Olsufka M, Longstreth Jr. WT et al. Pilot randomized clinical trial of prehospital induction of mild hypothermia in out-of-hospital cardiac arrest patients with a rapid infusion of 4 degrees C normal saline. Circulation 2007; 115: 3064-3070
    CrossrefPubMedGoogle Scholar
  • 57 Kamarainen A, Virkkunen I, Tenhunen J et al. Prehospital therapeutic hypothermia for comatose survivors of cardiac arrest: a randomized controlled trial. Acta Anaesthesiol Scand 2009; 53: 900-907
    CrossrefPubMedGoogle Scholar
  • 58 Kim F, Nichol G, Maynard C et al. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. JAMA 2014; 311: 45-52
    CrossrefPubMedGoogle Scholar