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Dtsch Med Wochenschr 2020; 145(08): 555-568
DOI: 10.1055/a-0665-6690
CME-Fortbildung

Reanimation – praktische Umsetzung von Leitlinien und Standards in der Klinik

Resuscitation – practical implementation of guidelines and standards in the hospital
Alexander Kersten
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Abstract

Out of hospital cardiac arrest (OHCA) requiring cardio-pulmonary resuscitation (CPR) remains a mojor public health concern. OHCA affects nearly 275 000 people in Europe annualy with more than 70 000 of those in Germany alone. It represents of the major causes of death in Europe.

In 40 % of patients CPR is successful and leads to a return of spontaneous circulation (ROSC). Due to the relevance of OHCA and CPR detailed guidelines with sound scientific foundation exist. However, even after successful CPR, mortality and morbidity remain high due to the severity of underlying diseases and sequelae of OHCA and CPR itself. Thus, optimization of the initial CPR treatment with reducing overall no-flow time (time from collaps with cardiac arrest to start of CPR) and optimization and streamlining of treatment algorithms and quality in hospitals receiving patients after cardiac arrest have been a strong focus to improve overall survival. Current guidelines suggest creation of Cardiac Arrest Centers as specialized hospitals who focus on high quality of post-resuscitation care with standardized processes and interdisciplinary treatment of patients after OHCA to establish fast, secure and effective treatment that is widely available in all regions.

This article will address the relevant items to be considered in daily practice of resuscitation and post-resuscitation care for cardiac arrest.

In den aktuellen internationalen Leitlinien zur Reanimation wird gefordert, prähospital reanimierte Patienten in spezialisierten Krankenhäusern (sog. Cardiac-Arrest-Zentren) weiterzubehandeln, die die Schwerpunkte der Postreanimationsbehandlung leitliniengerecht umsetzen und eine interdisziplinäre Versorgung auf höchstem Niveau mit Etablierung von standardisierten Prozessen und Verfahren gewährleisten. Dieser Artikel soll die für den praktischen klinischen Alltag relevanten Aspekte dieser Säulen der Reanimationsbehandlung aufarbeiten.

Schlüsselwörter

Wiederbelebung - Postreanimationsbehandlung - Reanimation - Leitlinie

Key words

CPR - OHCA - cardiac arrest - post-resuscitation care - public health, critical care


Publication History

Article published online:
15 April 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • Literatur

  • 1 Gräsner JT, Lefering R, Koster RW. et al Corrigendum to “EuReCa ONE-27 Nations, ONE Europe, ONE Registry. A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe”. Resuscitation 2016; 109: 145-146 . doi:10.1016/j.resuscitation.2016.10.001
    CrossrefPubMedGoogle Scholar
  • 2 Nyman J, Sihvonen M. Cardiopulmonary resuscitation skills in nurses and nursing students. Resuscitation 2000; 47 (02) 179-184 . doi:10.1016/S0300-9572(00)00226-4
    CrossrefPubMedGoogle Scholar
  • 3 Bobrow BJ, Zuercher M, Ewy GA. et al Gasping during cardiac arrest in humans is frequent and associated with improved survival. Circulation 2008; 118 (24) 2550-2554 . doi:10.1161/CIRCULATIONAHA.108.799940
    CrossrefPubMedGoogle Scholar
  • 4 Stipulante S, Tubes R, Fassi ElM. et al Implementation of the ALERT algorithm, a new dispatcher-assisted telephone cardiopulmonary resuscitation protocol, in non-Advanced Medical Priority Dispatch System (AMPDS) Emergency Medical Services centres. Resuscitation 2014; 85 (02) 177-181 . doi:10.1016/j.resuscitation.2013.10.005
    CrossrefPubMedGoogle Scholar
  • 5 Bray JE, Deasy C, Walsh J. et al Changing EMS dispatcher CPR instructions to 400 compressions before mouth-to-mouth improved bystander CPR rates. Resuscitation 2011; 82 (11) 1393-1398 . doi:10.1016/j.resuscitation.2011.06.018
    CrossrefPubMedGoogle Scholar
  • 6 Blom MT, Beesems SG, Homma PCM. et al Improved survival after out-of-hospital cardiac arrest and use of automated external defibrillators. Circulation 2014; 130 (21) 1868-1875 . doi:10.1161/CIRCULATIONAHA.114.010905
    CrossrefPubMedGoogle Scholar
  • 7 Nolan JP, Cariou A. Post-resuscitation care: ERC-ESICM Guidelines 2015. Intensive Care Med 2015; 41 (12) 2204-2206 . doi:10.1007/s00134-015-4094-5
    CrossrefPubMedGoogle Scholar
  • 8 Perkins GD, Ji C, Deakin CD. et al A randomized trial of epinephrine in out-of-hospital cardiac arrest. N Engl J Med 2018; 379 (08) 711-721 . doi:10.1056/NEJMoa1806842
    CrossrefPubMedGoogle Scholar
  • 9 Benoit JL, Gerecht RB, Steuerwald MT. et al Endotracheal intubation versus supraglottic airway placement in out-of-hospital cardiac arrest: A meta-analysis. Resuscitation 2015; 93: 20-26 . doi:10.1016/j.resuscitation.2015.05.007
    CrossrefPubMedGoogle Scholar
  • 10 Mentzelopoulos SD, Zakynthinos SG, Siempos I. et al Vasopressin for cardiac arrest: Meta-analysis of randomized controlled trials. Resuscitation 2012; 83 (01) 32-39 . doi:10.1016/j.resuscitation.2011.07.015
    CrossrefPubMedGoogle Scholar
  • 11 Dorian P, Cass D, Schwartz B. et al Amiodarone as Compared with Lidocaine for Shock-Resistant Ventricular Fibrillation. N Engl J Med 2002; 346 (12) 884-890 . doi:10.1056/NEJMoa013029
    CrossrefPubMedGoogle Scholar
  • 12 Yeung J, Chilwan M, Field R. et al The impact of airway management on quality of cardiopulmonary resuscitation: An observational study in patients during cardiac arrest. Resuscitation 2014; 85 (07) 898-904 . doi:10.1016/j.resuscitation.2014.02.018
    CrossrefPubMedGoogle Scholar
  • 13 Myerburg RJ, Halperin H, Egan DA. et al Pulseless electric activity. Circulation 2013; 128 (23) 2532-2541 . doi:10.1161/CIRCULATIONAHA.113.004490
    CrossrefPubMedGoogle Scholar
  • 14 Giberson B, Uber A, Gaieski FD. et al When to stop CPR and when to perform rhythm analysis. J Intensive Care Med 2016; 31 (08) 537-543 . doi:10.1177/0885066614561589
    CrossrefPubMedGoogle Scholar
  • 15 Rubertsson S, Lindgren E, Smekal D. et al Mechanical chest compressions and simultaneous defibrillation vs conventional cardiopulmonary resuscitation in out-of-hospital cardiac arrest: The LINC randomized trial. JAMA 2014; 311 (01) 53-61 . doi:10.1001/jama.2013.282538
    CrossrefPubMedGoogle Scholar
  • 16 Morrison LJ, Verbeek PR, Zhan C. et al Validation of a universal prehospital termination of resuscitation clinical prediction rule for advanced and basic life support providers. Resuscitation 2009; 80 (03) 324-328 . doi:10.1016/j.resuscitation.2008.11.014
    CrossrefPubMedGoogle Scholar
  • 17 Chan PS, Krumholz HM, Spertus JA. et al Automated external defibrillators and survival after in-hospital cardiac arrest. JAMA 2010; 304 (19) 2129-2136 . doi:10.1001/jama.2010.1576
    CrossrefPubMedGoogle Scholar
  • 18 Abella BS, Alvarado JP, Myklebust H. et al Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA 2005; 293 (03) 305-310 . doi:10.1001/jama.293.3.305
    CrossrefPubMedGoogle Scholar
  • 19 Andersen LW, Granfeldt A, Callaway CW. et al Association between tracheal intubation during adult in-hospital cardiac arrest and survival. JAMA 2017; 317 (05) 494-506 . doi:10.1001/jama.2016.20165
    CrossrefPubMedGoogle Scholar
  • 20 Søholm H, Wachtell K, Nielsen SL. et al Tertiary centres have improved survival compared to other hospitals in the Copenhagen area after out-of-hospital cardiac arrest. Resuscitation 2013; 84 (02) 162-167 . doi:10.1016/j.resuscitation.2012.06.029
    CrossrefPubMedGoogle Scholar
  • 21 Bro-Jeppesen J, Kjaergaard J, Wanscher M. et al Systemic inflammatory response and potential prognostic implications after out-of-hospital cardiac arrest: a substudy of the target temperature management trial*. Crit Care Med 2015; 43 (06) 1223-1232 . doi:10.1097/CCM.0000000000000937
    CrossrefPubMedGoogle Scholar
  • 22 Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002; 346 (08) 549-556 . doi:10.1056/NEJMoa012689
    CrossrefPubMedGoogle Scholar
  • 23 Bernard SA, Gray TW, Buist MD. et al Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002; 346 (08) 557-563 . doi:10.1056/NEJMoa003289
    CrossrefPubMedGoogle Scholar
  • 24 Lilja G, Nielsen N, Friberg H. et al Cognitive function in survivors of out-of-hospital cardiac arrest after target temperature management at 33°C Versus 36°C. Circulation 2015; 131 (15) 1340-1349 . doi:10.1161/CIRCULATIONAHA.114.014414
    CrossrefPubMedGoogle Scholar
  • 25 Xie A, Phan K, Yi-Chin Tsai M. et al Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock and Cardiac Arrest: A Meta-Analysis. J Cardiothorac Vasc Anesth 2015; 29 (03) 637-645 . doi:10.1053/j.jvca.2014.09.005
    CrossrefPubMedGoogle Scholar