Automatische externe Reanimationsgeräte

Zusammenfassung

In der Reanimationssituation müssen die professionellen Helfer trotz hoher Stresslevel und Zeitknappheit schnell, ressourceneffizient und zielführend Entscheidungen im Sinne des Patienten treffen: grundlegend dabei ist etwa das Abwägen zwischen dem Einsatz einer automatischen externen Reanimationshilfe zur kontinuierlichen, gleichmäßigen und ermüdungsfreien Durchführung der Thoraxkompressionen bis zum Wiedererreichen eines Eigenkreislaufs oder dem Abbruch der Maßnahmen.

Abstract

The use of automated chest compression devices (ACCD) is more and more common in cardiac arrest, where cardiopulmonary resuscitation (CPR) gets necessary. However, its use is only recommended in complex and prolonged rescue situations. The routine and uncritical use should be avoided given the missing data for a higher survival rate or better neurological outcome for patients getting an ACCD and not only manual chest compressions (mCC). Iatrogenic injuries are commonly observed as a consequence of sufficient chest compression during CPR as well-known complications and are not avoidable for the medical staff. The severity of injuries did not differ between ACCD or mCC. However, no chest compression-associated injury registered was fatal for the individual in case of frustrating CPR given that other conditions were causative earlier for the cardiac arrest, but these injuries registered might influence the post-CPR interval in case of initial survival dramatically. Therefore, the authors recommend a standard work-up including a computed tomography scan of the chest and abdomen for CPR-associated injuries in the clinical routine after return of spontaneous circulation as soon as possible.

Kernaussagen

• Die Anwendung von ACCD (Automated Chest Compression Device, mechanische Reanimationshilfe) zur kardiopulmonalen Reanimation (CPR) ist nur bei komplizierten und prolongierten Reanimationssituationen empfohlen.

• Vom routinemäßigen und unkritischen Dauereinsatz von ACCD ist mangels Patientenbenefit abzusehen.

• Reanimationsverletzungen müssen sowohl bei ACCD als auch mCC (manual Chest Compression, manuelle Thoraxkompression) in Kauf genommen werden und sind die Regel bei jedweder Form von suffizient durchgeführten Thoraxkompressionen.

• Reanimationsverletzungen sind bei frustranem CPR-Verlauf regelhaft nicht die Todesursache, könnten bei primärem Überleben aber den Therapieverlauf wesentlich beeinflussen.

• Deshalb ist bei erfolgreichem ROSC (Return of Spontaneous Circulation) ein Post-CPR-Evaluationsprotokoll inkl. zeitnahem Thorax- und Abdomen-CT in die Post-CPR-Versorgung zu integrieren.

Schlüsselwörter

automatische externe Reanimationsgeräte (ACCD) - kardiopulmonale Reanimation - LUCAS - Rechtsmedizin - Tod

Key words

automated chest compression device (ACCD) - cardiopulmonary resuscitation - LUCAS - legal medicine - death

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