Reanimation eines Säuglings – ST-Hebungsinfarkt und Kammerflimmern, nicht nur ein Phänomen des Erwachsenen

Zusammenfassung

Der plötzliche Herztod ist mit etwa 80 000 bis 100 000 Fällen pro Jahr eine der häufigsten Todesursachen in Deutschland (Reanimationsregister). Dabei sind Reanimationsereignisse in der Erwachsenenmedizin deutlich häufiger als in der Kinderheilkunde. Wir berichten über einen 7 Monate alten männlichen Säugling, der leblos in der elterlichen Wohnung vorgefunden wurde. Der Primärrhythmus war Kammerflimmern und wurde durch 2-malige biphasische elektrische Schockabgabe erfolgreich terminiert. Nach ROSC (return of spontaneous circulation) wurde der Säugling auf eine pädiatrische Intensivstation verbracht. Im angefertigten 12-Kanal-EKG sah man das Bild eines akuten ST-Hebungsinfarkts (STEMI) der Vorderwand, sodass eine invasive Koronardiagnostik erfolgte. Dort zeigte sich ein Komplettverschluss des R. interventricularis anterior (RIVA) sowie ausgeprägte Koronaraneurysmata der anderen Herzkranzgefäße auf dem Boden eines Kawasaki-Syndroms.

Abstract

With about 80 000 to 100 000 reported cases per year, sudden cardiac death is one of the most frequent causes of death in Germany. In this context, cardio-pulmonary resuscitations are much more common in adults compared to pediatric populations. We report a 7-month-old infant who was found lifeless at home. Primary ECG showed ventricular fibrillation, which was terminated by biphasic defibrillation. After return of spontaneous circulation (ROSC) the infant was transferred to a pediatric intensive care unit. A 12-lead ECG revealed an ST-elevated anterior myocardial infarction; immediate cardiac catheter examination showed a total occlusion of the anterior ramus interventricularis (RIVA). Additionally, pronounced coronary aneurysms based on Kawasaki disease were found.

Schlüsselwörter

präklinischer Herzkreislaufstillstand - Reanimation - Defibrillation - Kawasaki-Syndrom - Säugling

Key words

resuscitation - pediatrics - defibrillation - out-of-hospital cardiac arrest - Kawasaki disease

• Literatur

• 1 Atkins DL, Everson-Stewart S, Sears GK. et al. Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. Circulation 2009; 119: 1484-1491
• 2 Kato H, Ichinose E, Kawasaki T. Myocardial infarction in Kawasaki disease: clinical analyses in 195 cases. J Pediatr 1986; 108: 923-927
• 3 Javadzadegan H, Mehdizadeh Baghbani J, Farhang S. Acute myocardial infarction as the first manifestation of the incomplete Kawasaki disease in a young male. Cardiol Young 2009; 19: 635-637
• 4 Kawasaki T. [Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children]. Arerugi 1967; 16: 178-222
• 5 Newburger JW, Takahashi M, Gerber MA. et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004; 110: 2747-2771
• 6 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
• 7 Rechner JA, Loach VJ, Ali MT. et al. A comparison of the laryngeal mask airway with facemask and oropharyngeal airway for manual ventilation by critical care nurses in children. Anaesthesia 2007; 62: 790-795
• 8 Park C, Bahk JH, Ahn WS. et al. The laryngeal mask airway in infants and children. Can J Anaesth 2001; 48: 413-417
• 9 Hoffmann F, Keil J, Urban B. et al. Atemwegsmanagement mit supraglottischen Atemwegshilfen in der Kindernotfallmedizin – Larynxmaske ist State-of-the-art. Anästh Intensivmed 2016; 57: 377-386
• 10 Wirtz S, Eich C, Becke K. et al. [Use of cognitive aids in pediatric emergency care: Interdisciplinary consensus statement]. Anaesthesist 2017; 66: 340-346
• 11 Kaufmann J, Roth B, Engelhardt T. et al. Development and prospective federal state-wide evaluation of a device for height-based dose recommendations in prehospital pediatric emergencies: a simple tool to prevent most severe drug errors. Prehosp Emerg Care 2016;
• 12 Khine HH, Corddry DH, Kettrick RG. et al. Comparison of cuffed and uncuffed endotracheal tubes in young children during general anesthesia. Anesthesiology 1997; 86: 627-631
• 13 Helm M, Gries A, Fischer S. et al. [Invasive techniques in emergency medicine. III. Intraosseous punction – an alternative vascular access in paediatric emergencies]. Anaesthesist 2005; 54: 49-56
• 14 Meyburg J, Bernhard M, Hoffmann GF. et al. Principles of pediatric emergency care. Dtsch Arztebl Int 2009; 106: 739-747
• 15 Yamamoto T, Schindler E. Notfälle im Rettungsdienst und in der Klinik: Gefäßzugänge bei Kindern. Anasthesiol Intensivmed Notfallmed Schmerzther 2017; 52: 55-64
• 16 Buck ML, Wiggins BS, Sesler JM. Intraosseous drug administration in children and adults during cardiopulmonary resuscitation. Ann Pharmacother 2007; 41: 1679-1686
• 17 Schroth M, Hossfeld B. Leserbrief zum Beitrag: M. Hufnagel „Intraossärer Zugang – Komplikation kann zur Amputation führen“. Notarzt 2016; 32: 205
• 18 Hickey RW, Cohen DM, Strausbaugh S. et al. Pediatric patients requiring CPR in the prehospital setting. Ann Emerg Med 1995; 25: 495-501
• 19 Rossano JW, Quan L, Kenney MA. et al. Energy doses for treatment of out-of-hospital pediatric ventricular fibrillation. Resuscitation 2006; 70: 80-89
• 20 Mogayzel C, Quan L, Graves JR. et al. Out-of-hospital ventricular fibrillation in children and adolescents: causes and outcomes. Ann Emerg Med 1995; 25: 484-491
• 21 Young KD, Seidel JS. Pediatric cardiopulmonary resuscitation: a collective review. Ann Emerg Med 1999; 33: 195-205
• 22 Gurnett CA, Atkins DL. Successful use of a biphasic waveform automated external defibrillator in a high-risk child. Am J Cardiol 2000; 86: 1051-1053
• 23 Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002; 346: 549-556
• 24 Moler FW, Silverstein FS, Holubkov R. et al. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. N Engl J Med 2015; 372: 1898-1908