Laienreanimation – Kontroversen in der Notfallmedizin: mit oder ohne Beatmung?

Zusammenfassung

Die Ergebnisse der Literaturanalyse zur Beatmung bei der Laienreanimation sind widersprüchlich. Beobachtungsstudien großer Reanimationsregister zeigen bessere Überlebensraten für die Laienreanimation mit Beatmung (insbesondere bei nicht kardialer Genese und prolongierten Eintreffzeiten des Rettungsdienstes). Gleichzeitig konnten in einer Region mit kurzen Eintreffzeiten des Rettungsdienstes durch ein engagiertes, einfaches Programm (Laienreanimation ohne Beatmung) Laienreanimations- und Überlebensraten gesteigert werden.

Die Empfehlungen der ERC-Leitlinien 2010 lösen diesen Widerspruch auf. Jeder Helfer soll zumindest auf den Brustkorb drücken (Thoraxkompressionen). Für trainierte Helfer ist die Kombination mit Beatmung die Methode der Wahl. Bei der Telefonreanimation sind die Ergebnisse eindeutig. Komplexität und Zeitverlust einer Telefonanleitung der Mund-zu-Mund-Beatmung und damit verknüpfte schlechtere Überlebensraten führen hier zur Empfehlung kontinuierlicher Thoraxkompressionen.

Abstract

An analysis of literature results reveals differences concerning the need for rescue breathing in lay-rescuer cardiopulmonary-resuscitation (CPR). Observational studies on large registries have shown improved survival rates with standard CPR (chest compressions and rescue breathing) compared to continuous chest compressions (CCC). This applies especially for cardiac arrests of non-cardiac origin or prolonged EMS-arrival times. In contrast a public program for lay-rescuers focusing on CCC lead to improved success rates of bystander-CPR, followed by improved survival rates. The 2010 ERC guidelines have resolved this controversy by integrating both aspects. CCC is recommended for everyone. Trained bystanders should use standard-CPR as method of choice. For dispatcher-assisted CPR the results are clear. Giving instructions for mouth-to-mouth ventilation is too complicated and time consuming, thus impairing survival rates. Therefore CCC is recommended for dispatcher-assisted CPR.

Schlüsselwörter:

Laienreanimation - Beatmung - Überlebensraten - Telefonreanimation

Key words

CPR - lay-rescuer - rescue breathing - survival - dispatcher-assisted CPR

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