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DOI: 10.1055/a-0759-0476
Postreanimationsbehandlung bei Kindern
Publikationsverlauf
Publikationsdatum:
10. Februar 2020 (online)
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In den deutschsprachigen Ländern erleiden jährlich etwa 5000 Kinder einen Atem-Kreislauf-Stillstand. Die Prognose der Kinder kann durch multimodale Maßnahmen während und nach erfolgreicher Reanimation positiv beeinflusst werden. Dieser Artikel greift den aktuellen Kenntnisstand der Postreanimationsbehandlung auf und strukturiert das praktische Vorgehen.
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Die Aufrechterhaltung der Homöostase mit strikter Normoxie, Normoventilation und Normotension sowie konsequenter Vermeidung einer Hyperthermie haben entscheidenden Einfluss auf die Schwere des Post Cardiac Arrest Syndrome.
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Die Gesamtprognose hängt insbesondere vom Ausmaß der hypoxisch-ischämischen Enzephalopathie ab.
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Eine Prognoseeinschätzung kann i. d. R. erst Tage nach dem Atem-Kreislauf-Stillstand erfolgen und basiert auf der klinischen Verlaufsbeobachtung in Kombination mit multimodalen Untersuchungsergebnissen.
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Eine frühzeitige Betreuung der Eltern schwer kranker Kinder kann Ängste lindern und sich positiv auf den Krankheitsverlauf des Kindes auswirken.
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Debriefing des Behandlungsteams ist ein wichtiges Instrument zur Steigerung der Behandlungsqualität.
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Literatur
- 1 Seewald S, Brenner S, Fischer M. et al. Jahresbericht des Deutschen DGAInfo. Reanimationsregisters. Innerklinische Reanimation 2018. Anästh Intensivmed 2019; 60: V1-V3
- 2 German Resuscitation Council. heldkannjeder – Das Einmaleins der Wiederbelebung. Bundesweite Aufklärungskampagne für Laienreanimation. 16.9.2019. Im Internet: https://www.grc-org.de/projekte/18-2-Das-Einmaleins-der-Wiederbelebung Stand: 14.01.2020
- 3 Girotra S, Spertus JA, Li Y. et al. for the American Heart Association. Get With the Guidelines-Resuscitation Investigators. Survival trends in pediatric in-hospital cardiac arrests: an analysis from Get With the Guidelines-Resuscitation. Circ Cardiovasc Qual Outcomes 2013; 6: 42-49 doi:10.1161/CIRCOUTCOMES.112.967968
- 4 Jayaram N, McNally B, Tang F. et al. Survival after out-of-hospital cardiac arrest in children. J Am Heart Assoc 2015; 4: e002122 doi:10.1161/JAHA.115.002122
- 5 Topjian AA, de Caen A, Wainwright MS. et al. Pediatric post-cardiac arrest care: a scientific statement from the American Heart Association. Circulation 2019; 140: e194-e233 doi:10.1161/CIR0000000000000697
- 6 Scholz KJ, Andresen B, Böttiger BW. et al. Qualitätsindikatoren und strukturelle Voraussetzungen für Cardiac-Arrest-Zentren – Deutscher Rat für Wiederbelebung/German Resuscitation Council (GRC). Notfall Rettungsmed 2017; 20: 234-236
- 7 Winkler S, Brenner S. Die intensivmedizinische Erstversorgung des Kindes. Anästh Intensivmed 2018; 59: 68-87
- 8 OʼLeary F, Hayen A, Lockie F. et al. Defining normal ranges and centiles for heart and respiratory rates in infants and children: a cross-sectional study of patients attending an Australian tertiary hospital paediatric emergency department. Arch Dis Child 2015; 100: 733-737
- 9 Jöhr M. Hrsg. Kinderanästhesie. 9. Aufl.. München, Jena: Urban & Fischer; 2019
- 10 Brenner S. Atem-Kreislauf-Stillstand: Erkennen und Behandeln reversibler Ursachen. Pädiatrie 2018; 30: :28-30
- 11 Schmidt J, Strauß JM, Becke K. et al. Handlungsempfehlung zur Rapid-Sequence-Induction im Kindesalter. Anästh Intensivmed 2007; 48: S88-S93
- 12 Boone MD, Jinadasa SP, Mueller A. et al. The effect of positive end-expiratory pressure on intracranial pressure and cerebral hemodynamics. Neurocrit Care 2017; 26: 174-181 doi:10.1007/s12028-016-0328-9
- 13 Ferguson LP, Durward A, Tibby SM. Relationship between arterial partial oxygen pressure after resuscitation from cardiac arrest and mortality in children. Circulation 2012; 126: 335-342 doi:10.1161/CIRCULATIONAHA.111.085100
- 14 Kilgannon JH, Jones AE, Shapiro NI. et al. Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA 2010; 303: 2165-2171
- 15 Bennett KS, Clark AE, Meert KL. et al. Pediatric Emergency Care Medicine Applied Research Network. Early oxygenation and ventilation measurements after pediatric cardiac arrest: lack of association with outcome. Crit Care Med 2013; 41: 1534-1542 doi:10.1097/CCM.0b013e318287f54c
- 16 Guerra-Wallace MM, Casey FL3rd Bell MJ. et al. Hyperoxia and hypoxia in children resuscitated from cardiac arrest. Pediatr Crit Care Med 2013; 14: e143-e148 doi:10.1097/PCC.0b013e3182720440
- 17 Del Castillo J, López-Herce J, Matamoros M. et al. Iberoamerican Pediatric Cardiac Arrest Study Network RIBEPCI. Hyperoxia, hypocapnia and hypercapnia as outcome factors after cardiac arrest in children. Resuscitation 2012; 83: 1456-1461 doi:10.1016/j.resuscitation.2012.07.019
- 18 Topjian AA, French B, Sutton RM. et al. Early postresuscitation hypotension is associated with increased mortality following pediatric cardiac arrest. Crit Care Med 2014; 42: 1518-1523 doi:10.1097/CCM0000000000000216
- 19 Topjian AA, Telford R, Holubkov R. et al. Therapeutic Hypothermia After Pediatric Cardiac Arrest (THAP-CA) Trial Investigators. Association of early postresuscitation hypotension with survival to discharge after targeted temperature management for pediatric out-of-hospital cardiac arrest: secondary analysis of a randomized clinical trial. JAMA Pediatr 2018; 172: 143-153 doi:10.1001/jamapediatrics.2017.4043
- 20 Lin YR, Li CJ, Wu TK. et al. Post-resuscitative clinical features in the first hour after achieving sustained ROSC predict the duration of survival in children with non-traumatic out-of-hospital cardiac arrest. Resuscitation 2010; 81: 410-417 doi:10.1016/j.resuscitation.2010.01.006
- 21 Walters EL, Morawski K, Dorotta I. et al. Implementation of a post-cardiac arrest care bundle including therapeutic hypothermia and hemodynamic optimization in comatose patients with return of spontaneous circulation after out-of-hospital cardiac arrest: a feasibility study. Shock 2011; 35 (04) 360-366 doi:10.1097/SHK.0b013e318204c106
- 22 Morales DL, Zafar F, Rossano JW. et al. Use of ventricular assist devices in children across the United States: analysis of 7.5 million pediatric hospitalizations. Ann Thorac Surg 2010; 90: 1313-1318 doi:10.1016/j.athoracsur.2010.04.107
- 23 Blume ED, Rosenthal DN, Rossano JW. et al. Outcomes of children implanted with ventricular assist devices in the United States: first analysis of the Pediatric Interagency Registry for Mechanical Circulatory Support (PediMACS). J Heart Lung Transplant 2016; 35: 578-584 doi:10.1016/j.healun.2016.01.1227
- 24 Rajagopal SK, Almond CS, Laussen PC. et al. Extracorporeal membrane oxygenation for the support of infants, children, and young adults with acute myocarditis: a review of the Extracorporeal Life Support Organization registry. Crit Care Med 2010; 38: 382-387 doi:10.1097/CCM.0b013e3181bc8293
- 25 Neumayr TM, Gill J, Fitzgerald JC. et al. Identifying risk for acute kidney injury in infants and children following cardiac arrest. Pediatr Crit Care Med 2017; 18: e446-e454 doi:10.1097/PCC0000000000001280
- 26 Moler FW, Silverstein FS, Holubkov R. et al. Therapeutic hypothermia after in-hospital cardiac arrest in children. N Engl J Med 2017; 376: 318-329 doi:10.1056/NEJMoa1610493
- 27 Moler FW, Silverstein FS, Holubkov R. et al. for the THAPCA Trial Investigators. Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest in Children. N Engl J Med 2015; 372: 1898-1908 doi:10.1056/NEJMoa1411480
- 28 AWMF. S3-Leitlinie 001/012: Analgesie, Sedierung und Delirmanagement in der Intensivmedizin, 08/2015.
- 29 Weber K, Kohl-Sobania M, Härtel C. Ernährungsmanagement kritisch kranker Kinder. Intensivmed up2date 2018; 14: 331-343 doi:10.1055/s-0043-121061
- 30 Jacobs A, Verlinden I, Vanhorebeek I. et al. Early supplemental parenteral nutrition in critically ill children: an update. J Clin Med 2019; 8: pii:E830 doi:10.3390/jcm8060830
- 31 Agus MS, Wypij D, Hirshberg EL. et al. Tight glycemic control in critically ill children. N Engl J Med 2017; 376: 729-741 doi:10.1056/NEJMoa1612348
- 32 Meert KL, Donaldson A, Nadkarni V. et al. Pediatric Emergency Care Applied Research Network. Multicenter cohort study of in-hospital pediatric cardiac arrest. Pediatr Crit Care Med 2009; 10: 544-553 doi:10.1097/PCC.0b013e3181a7045c
- 33 Mesotten D, Joosten K, van Kempen A. et al. ESPGHAN/ESPEN/ESPR/CSPEN working group on pediatric parenteral nutrition. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Carbohydrates. Clin Nutr 2018; 37 (6 Pt B): 2337-2343 doi:10.1016/j.clnu.2018.06.947
- 34 Sandroni C, DʼArrigo S, Callaway CW. et al. The rate of brain death and organ donation in patients resuscitated from cardiac arrest: a systematic review and meta-analysis. Intensive Care Med 2016; 42: 1661-1671
- 35 Hayman EG, Patel AP, Kimberly T. et al. Cerebral edema after cardiopulmonary resuscitation: a therapeutic target following cardiac arrest?. Neurocrit Care 2018; 28: 276-287
- 36 Kochanek PM, Tasker RC, Bell MJ. et al. Management of pediatric severe traumatic brain injury: 2019 consensus and guidelines-based algorithm for first and second tier therapies. Pediatr Crit Care Med 2019; 20: 269-279 doi:10.1097/PCC0000000000001737
- 37 Paal P, Gordon L, Strapazzon G. et al. Accidental hypothermia – an update. Scand J Trauma Resusc Emerg Med 2016; 24: 111
- 38 Maconochie IK, Bingham R, Eich C. et al. Paediatric life support section Collaborators. European resuscitation council guidelines for resuscitation 2015: Section 6. Paediatric life support. Resuscitation 2015; 95: 223-248
- 39 Brenner S, Eich C, Rellensmann G. et al. Recommendation on temperature management after cardiopulmonary arrest and severe traumatic brain injury in childhood beyond the neonatal period: Statement of the German Society for Neonatology and Pediatric Intensive Care Medicine (GNPI) and the scientific Working Group for Paediatric Anaesthesia (WAKKA) of the German Society of Anaesthesiology and Intensive Care (DGAI). Anaesthesist 2017; 66: 128-133 doi:10.1007/s00101-016-0256-2
- 40 Mandel R, Martinot A, Delepoulle F. et al. Prediction of outcome after hypoxic-ischemic encephalopathy: a prospective clinical and electrophysiologic study. J Pediatr 2002; 141: 45-50 doi:10.1067/mpd.2002.125005
- 41 Carter BG, Butt W. A prospective study of outcome predictors after severe brain injury in children. Intensive Care Med 2005; 31: 840-845.211 doi:10.1007/s00134-005-2634-0
- 42 Abend NS, Topjian AA, Kessler SK. et al. Outcome prediction by motor and pupillary responses in children treated with therapeutic hypothermia after cardiac arrest. Pediatr Crit Care Med 2012; 13: 32-38 doi:10.1097/PCC.0b013e3182196a7b
- 43 Dragancea I, Horn J, Kuiper M. et al. Neurological prognostication after cardiac arrest and targeted temperature management 33 °C versus 36 °C: Results from a randomised controlled clinical trial. Resuscitation 2015; 93: 164-170 doi:10.1016/j.resuscitation.2015.04.013
- 44 Rossetti AO, Rabinstein AA, Oddo M. Neurological prognostication of outcome in patients in coma after cardiac arrest. Lancet Neurology 2016; 15: 597-609.( doi:10.1016/S1474-4422(16)00015-6
- 45 Ponz I, Lopez-de-Sa E, Armada E. et al. Influence of the temperature on the moment of awakening in patients treated with therapeutic hypothermia after cardiac arrest. Resuscitation 2016; 103: 32-36 doi:10.1016/j.resuscitation.2016.03.017
- 46 Callaway CW, Donnino MW, Fink EL. et al. Part 8: post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care [published correction appeared in Circulation 2017; 136: e197]. Circulation 2015; 132: S465-S482 doi:10.1161/cir0000000000000262
- 47 Ducharme-Crevier L, Press CA, Kurz JE. et al. Early presence of sleep spindles on electroencephalography is associated with good outcome after pediatric cardiac arrest. Pediatr Crit Care Med 2017; 18: 452-460 doi:10.1097/PCC0000000000001137
- 48 Kessler SK, Topjian AA, Gutierrez-Colina AM. et al. Short-term outcome prediction by electroencephalographic features in children treated with therapeutic hypothermia after cardiac arrest. Neurocrit Care 2011; 14: 37-43 doi:10.1007/s12028-010-9450-2
- 49 Topjian AA, Sánchez SM, Shults J. et al. Early electroencephalographic background features predict outcomes in children resuscitated from cardiac arrest. Pediatr Crit Care Med 2016; 17: 547-557 doi:10.1097/PCC0000000000000740
- 50 Abend NS, Topjian A, Ichord R. et al. Electroencephalographic monitoring during hypothermia after pediatric cardiac arrest. Neurology 2009; 72: 1931-1940 doi:10.1212/WNL.0b013e3181a82687
- 51 Glauser T, Shinnar S, Gloss D. et al. Evidence-based guideline: Treatment of convulsive status epilepticus in children and adults: Report of the guideline committee of the American Epilepsy Society. Epilepsy Currents 2016; 16: 48-61 doi:10.5698/1535-7597-16.1.48
- 52 Lin JJ, Hsia SH, Wang HS. et al. Transcranial Doppler ultrasound in therapeutic hypothermia for children after resuscitation. Resuscitation 2015; 89: 182-187 doi:10.1016/j.resuscitation.2015.01.029
- 53 Hirsch KG, Mlynash M, Eyngorn I. et al. Multi-center study of diffusion-weighted imaging in coma after cardiac arrest. Neurocritical Care 2016; 24: 82-89 doi:10.1007/s12028-015-0179-9
- 54 Mlynash M, Campbell DM, Leproust EM. et al. Temporal and spatial profile of braindiffusion-weighted MRI after cardiac arrest. Stroke 2010; 41: 1665-1672
- 55 Topjian AA, Lin R, Morris MC. et al. Neuron-specific enolase and S-100B are associated with neurologic outcome after pediatric cardiac arrest. Pediatr Crit Care Med 2009; 10: 479-490 doi:10.1097/PCC.0b013e318198bdb5
- 56 Prout AJ, Wolf MS, Fink EL. Translating biomarkers from research to clinical use in pediatric neurocritical care: focus on traumatic brain injury and cardiac arrest. Curr Opin Pediatr 2017; 29: 272-279 doi:10.1097/MOP0000000000000488
- 57 Van den Heuvel I, Nolte-Buchholtz S, Rellensmann G. Pädiatrische Intensiv- und Palliativmedizin – unsere Patienten brauchen beides!. Intensivmed Up2date 2019; 15: 91-110 doi:10.1055/s-0043-121669
- 58 Del Castillo J, López-Herce J, Cañadas S. et al. Iberoamerican Pediatric Cardiac Arrest Study Network RIBEPCI. Cardiac arrest and resuscitation in the pediatric intensive care unit: a prospective multicenter multinational study. Resuscitation 2014; 85: 1380-1386 doi:10.1016/j.resuscitation.2014.06.024
- 59 Bhanji F, Topjian AA, Nadkarni VM. et al. Survival rates following pediatric in-hospital cardiac arrests during nights and weekends. JAMA Pediatr 2017; 171: 39-45 doi:10.1001/jamapediatrics.2016.2535
- 60 Kitamura T, Kiyohara K, Nitta M. et al. Survival following witnessed pediatric out-of-hospital cardiac arrests during nights and weekends. Resuscitation 2014; 85: 1692-1698 doi:10.1016/j.resuscitation.2014.08.035
- 61 Moler FW, Donaldson AE, Meert K. et al. Pediatric Emergency Care Applied Research Network. Multicenter cohort study of out-of-hospital pediatric cardiac arrest. Crit Care Med 2011; 39: 141-149 doi:10.1097/CCM.0b013e3181fa3c17
- 62 Raymond TT, Stromberg D, Stigall W. et al. American Heart Associationʼs Get With The Guidelines-Resuscitation Investigators. Sodium bicarbonate use during in-hospital pediatric pulseless cardiac arrest – a report from the American Heart Association Get With The Guidelines (®)-Resuscitation. Resuscitation 2015; 89: 106-113 doi:10.1016/j.resuscitation.2015.01.007
- 63 Andersen LW, Berg KM, Saindon BZ. et al. American Heart Association Get With the Guidelines-Resuscitation Investigators. Time to epinephrine and survival after pediatric in-hospital cardiac arrest. JAMA 2015; 314: 802-810 doi:10.1001/jama.2015.9678
- 64 Hara M, Hayashi K, Kitamura T. Outcomes differ by first documented rhythm after witnessed out-of-hospital cardiac arrest in children: an observational study with prospective nationwide population-based cohort database in Japan. Eur Heart J Qual Care Clin Outcomes 2017; 3: 83-92 doi:10.1093/ehjqcco/qcw040
- 65 Fukuda T, Kondo Y, Hayashida K. et al. Time to epinephrine and survival after paediatric out-of-hospital cardiac arrest. Eur Heart J Cardiovasc Pharmacother 2018; 4: 144-151 doi:10.1093/ehjcvp/pvx023
- 66 Sutton RM, French B, Niles DE. et al. 2010 American Heart Association recommended compression depths during pediatric in-hospital resuscitations are associated with survival. Resuscitation 2014; 85: 1179-1184 doi:10.1016/j.resuscitation.2014.05.007
- 67 Berg RA, Sutton RM, Reeder RW. et al. for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) PICqCPR (Pediatric Intensive Care Quality of Cardio-Pulmonary Resuscitation) Investigators. Association between diastolic blood pressure during pediatric in-hospital cardiopulmonary resuscitation and survival. Circulation 2018; 137: 1784-1795 doi:10.1161/CIRCULATIONAHA.117.032270
- 68 Becke K, Eich C, Höhne C. et al. Kinderanästhesie – was wirklich wichtig ist. Dtsch Arztebl 2017; 114: A-166/B-148/C-148
- 69 Okubo M, Kiyohara K, Iwami T. et al. Nationwide and regional trends in survival from out-of-hospital cardiac arrest in Japan: A 10-year cohort study from 2005 to 2014. Resuscitation 2017; 115: 120-128 doi:10.1016/j.resuscitation.2017.03.036
- 70 Berg RA, Nadkarni VM, Clark AE. et al. Incidence and outcomes of cardio-pulmonary resuscitation in PICUs. Crit Care Med 2016; 44: 798-808 doi:10.1097/ccm0000000000001484
- 71 Fiser DH. Assessing the outcome of pediatric intensive care. J Pediatr 1992; 121: 68-74
- 72 Schiff A. Warten Sie doch bitte draußen! Zum Umgang mit Angehörigen in Krisensituationen. Dr. med. Mabuse, Schwerpunkt Trauma 2015; 213: 31-33
- 73 Müller W, Scheuermann U. Praxis Krisenintervention. Ein Handbuch für helfende Berufe: Psychologen, Ärzte, Sozialpädagogen, Pflege- und Rettungskräfte. 2. Aufl.. Ortiz-Müller W, Scheuermann U, Gahleitner B, Hrsg. Stuttgart: Kohlhammer Verlag; 2010
- 74 McGahey-Oakland PR, Lieder HS, Young A. et al. Family experiences during resuscitation at a childrenʼs hospital emergency department. J Pediatr Health Care 2007; 21: 217-225
- 75 Maxton FJ. Parental presence during resuscitation in the PICU: the parentsʼ experience. Sharing and surviving the resuscitation: a phenomenological study. J Clin Nurs 2008; 17: 3168-3176 doi:10.1111/j.1365-2702.2008.02525.x
- 76 Kremp A, Schmitz R. Reanimation im Beisein von Angehörigen, insbesondere der Eltern. In: Schiff A. Hrsg. Die Perspektive der professionellen Helfer. Familien in kritischen Situationen der klinischen Pflege. Leverkusen: Barbara Budrich Verlag; 2014: 89-92
- 77 Mitchell JT, Everly GS. Criticial Incident Stress Management. Handbuch Einsatznachsorge. Psychosoziale Unterstützung nach der Mitchell-Methode. 3. Aufl.. Edewecht: Stumpf & Kossendey; 2019
- 78 Sieg L, Friedrich L, Eismann H. Lernen im geschützten Umfeld: Implementierung in die Fort- und Weiterbildung. Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 35-46 doi:10.1055/s-0043-105259
- 79 Bengel J. Notfallpsychologische Interventionen bei akuter Belastungsstörung. In: Maercker A. Hrsg. Therapie der posttraumatischen Belastungsstörungen. Berlin, Heidelberg: Springer; 2003: 185-203
- 80 Lauria MJ, Gallo IA, Rush S. et al. Psychological skills to improve emergency care providersʼ performance under stress. Ann Emerg Med 2017; 70: 884-890 doi:10.1016/j.annemergmed.2017.03.018