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Der Klinikarzt 2016; 45(06): 312-319
DOI: 10.1055/s-0042-109037
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© Georg Thieme Verlag Stuttgart · New York

Der automatisierte externe Defibrillator in der Notfall- und Rettungsmedizin

Hat dieses Konzept die Erwartungen erfüllt?The automated external defibrillator in the emergency and rescue medicine – Does this concept has met the expectations?
Hans-Joachim Trappe
1   Medizinische Klinik II (Kardiologie und Angiologie – Marien Hospital Herne, Universitätsklinik der Ruhr-Universität Bochum
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Publication Date:
29 June 2016 (online)

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In Deutschland versterben jährlich etwa 70 000 – 100 000 Menschen an einem plötzlichen Herztod (PHT). Der PHT ist nicht durch einzelne Faktoren bedingt, sondern als multifaktorielles Geschehen zu verstehen. In etwa 50 % der Fälle ist der plötzliche Herztod die Erstmanifestation einer Herzkrankheit. Der plötzliche Herztod wird in etwa 90 % durch ventrikuläre Tachyarrhythmien hervorgerufen, während bradykarde Rhythmusstörungen nur in etwa 5–10% zum plötzlichen Herztod führen. Eine sichere Risikoidentifikation von Patienten, die hinsichtlich eines plötzlichen Herztods gefährdet sind, ist bisher nicht gelungen. Die schnelle Defibrillation ist die beste Maßnahme, Kammerflimmern zu terminieren. Die Verfügbarkeit automatisierter externer Defibrillatoren (AED) deshalb unerlässlich an Plätzen mit vielen Menschen. Es ist inzwischen unbestritten, dass die Defibrillation durch Laien mithilfe von AED zu einer wesentlichen Verbesserung der Überlebensrate von Patienten mit Kammerflimmern führt. Es scheint sinnvoll, neben Maßnahmen zur Kardiokompression auch die Therapie mit dem AED bereits in Schulen, auch bei Kindern und Jugendlichen, vorzustellen und zu trainieren. Die AED-Therapie „zu Hause“ hat sich nicht bewährt und steigert die Überlebensrate nicht.

In Germany approximately 70 000–100 000 SCD patients (pts) die from sudden cardiac death (SCD). SCD is not caused by a single factor but is a multifactorial problem. In 50 % of SCD victims, sudden cardiac death is the first manifestation of a heart disease. SCD is caused by ventricular tachyarrhythmias in approximately 90 % of pts, whereas SCD is caused by bradyarrhythmias in 5–10 % of the pts Risk stratification is not possible in the majority of them prior to the fatal event. Early defibrillation is the method of choice to terminate ventricular fibrillation. Therefore, it is mandatory to install automatic external defibrillators (AED) in places with many people. There is general agreement that early defibrillation with automated external defibrillators (AED) is an effective tool to treat pts with ventricular fibrillation and will improve survival. It seems necessary to teach cardiocompression and AED use, also in children and adolescents. AED therapy “at home” did not improve survival in patients with cardiac arrest and can not be recommended.

Key words

Sudden death - ventricular fibrillation - defibrillation - automated external defibrillator (AED)
 

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