Leitlinien des European Resuscitation Council 2021

Dieser Beitrag basiert auf den 2021 veröffentlichten Leitlinien des ERC und fasst die Inhalte der drei Kapitel Epidemiologie, lebensrettende Systeme und Lehre in der Reanimation zusammen. Im Fokus steht u. a. das optimierte Zusammenspiel aller Beteiligten der sog. Überlebenskette, vor allem durch eine Verbesserung der Laienreanimationsquote und der Reanimationsqualität. Eine effiziente Lehre in der Reanimation ist die Basis für eine bestmögliche praktische Umsetzung mit dem ultimativen Ziel der Verbesserung des Überlebens der Patienten.

Kernaussagen

• Die wahre Inzidenz des Kreislaufstillstands in Europa ist nach wie vor nicht genau bekannt und variiert zwischen den einzelnen europäischen Ländern und Regionen erheblich.

• Wesentlicher Faktor zur Verbesserung des Outcomes nach CPR stellt eine Systemkonfiguration dar, die ein perfektes Zusammenspiel der „Chain of Survival“ garantiert. Innerklinisch soll durch Frühwarnsysteme und innerklinische schnelle Eingreifteams das Auftreten eines Kreislaufstillstands möglichst verhindert werden.

• Die drei Faktoren der Überlebensformel für ein verbessertes Überleben sind die Leitlinienqualität (Wissenschaft), eine effiziente Ausbildung der Helfer (Ausbildung) und eine gut funktionierende lokale Überlebenskette (lokale Umsetzung).

• Bereits jüngere Kinder sind in der Lage, einen Kreislaufstillstand zu erkennen und Hilfe zu rufen. Allen Schulkindern soll das Konzept „Prüfen – Rufen – Drücken“ beigebracht werden.

• Die individuelle Lebensqualität der Überlebenden nach Kreislaufstillstand kann trotz als gut eingestuftem neurologischem Outcome stark vermindert sein, und es besteht Bedarf an einer besseren Bereitstellung von Rehabilitationsmöglichkeiten, speziell nach erfolgter Reanimation.

• Human Factors sind essenziell für eine qualitativ hochwertige Reanimation, und die vermehrte Aufmerksamkeit für diese nicht technischen Fähigkeiten kann medizinische Fehler reduzieren und die Patientensicherheit erhöhen.

Schlüsselwörter

Herz-Kreislauf-Stillstand - Wiederbelebung - Advanced Life Support - Leitlinie - Epidemiologie - Systems Saving Lives - Out of Hospital Cardiac Arrest - In Hospital Cardiac Arrest - Reanimationsschulung

Publikationsverlauf

Artikel online veröffentlicht:
01. März 2022

• Literatur

• 1 Andersen LW, Holmberg MJ, Berg KM. et al. In-Hospital Cardiac Arrest: A Review. JAMA 2019; 321: 1200-1210 DOI: 10.1001/jama.2019.1696.
• 2 Gräsner J-T, Wnent J, Herlitz J. et al. Survival after out-of-hospital cardiac arrest in Europe – Results of the EuReCa TWO study. Resuscitation 2020; 148: 218-226 DOI: 10.1016/j.resuscitation.2019.12.042.
• 3 Kiguchi T, Okubo M, Nishiyama C. et al. Out-of-hospital cardiac arrest across the World: First report from the International Liaison Committee on Resuscitation (ILCOR). Resuscitation 2020; 152: 39-49 DOI: 10.1016/j.resuscitation.2020.02.044.
• 4 Cummins RO, Chamberlain DA, Abramson NS. et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 1991; 84: 960-975 DOI: 10.1161/01.cir.84.2.960.
• 5 Perkins GD, Jacobs IG, Nadkarni VM. et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Resuscitation 2015; 96: 328-340 DOI: 10.1016/j.resuscitation.2014.11.002.
• 6 Gräsner J-T, Herlitz J, Tjelmeland IBM. et al. Epidemiologie des Kreislaufstillstands in Europa. Notfall + Rettungsmedizin 2021; 24: 346-366 DOI: 10.1007/s10049-021-00884-y.
• 7 Gräsner J-T, Lefering R, Koster RW. et al. 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; 105: 188-195 DOI: 10.1016/j.resuscitation.2016.06.004.
• 8 Tjelmeland IBM, Alm-Kruse K, Andersson L-J. et al. Cardiac arrest as a reportable condition: a cohort study of the first 6 years of the Norwegian out-of-hospital cardiac arrest registry. BMJ Open 2020; 10: e038133 DOI: 10.1136/bmjopen-2020-038133.
• 9 Nikolaou N, Castrén M, Monsieurs KG. et al. Time delays to reach dispatch centres in different regions in Europe. Are we losing the window of opportunity? – The EUROCALL study. Resuscitation 2017; 111: 8-13 DOI: 10.1016/j.resuscitation.2016.10.026.
• 10 Ageron F-X, Debaty G, Gayet-Ageron A. et al. Impact of an emergency medical dispatch system on survival from out-of-hospital cardiac arrest: a population-based study. Scand J Trauma Resusc Emerg Med 2016; 24: 53 DOI: 10.1186/s13049-016-0247-y.
• 11 Considine J, Gazmuri RJ, Perkins GD. et al. Chest compression components (rate, depth, chest wall recoil and leaning): A scoping review. Resuscitation 2020; 146: 188-202 DOI: 10.1016/j.resuscitation.2019.08.042.
• 12 Cummins RO, Ornato JP, Thies WH. et al. Improving survival from sudden cardiac arrest: the “chain of survival” concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation 1991; 83: 1832-1847 DOI: 10.1161/01.cir.83.5.1832.
• 13 Hasselqvist-Ax I, Riva G, Herlitz J. et al. Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest. N Engl J Med 2015; 372: 2307-2315 DOI: 10.1056/NEJMoa1405796.
• 14 Christensen DM, Rajan S, Kragholm K. et al. Bystander cardiopulmonary resuscitation and survival in patients with out-of-hospital cardiac arrest of non-cardiac origin. Resuscitation 2019; 140: 98-105 DOI: 10.1016/j.resuscitation.2019.05.014.
• 15 Böttiger BW, Lockey A, Aickin R. et al. “All citizens of the world can save a life” – The World Restart a Heart (WRAH) initiative starts in 2018. Resuscitation 2018; 128: 188-190 DOI: 10.1016/j.resuscitation.2018.04.015.
• 16 Claesson A, Fredman D, Svensson L. et al. Unmanned aerial vehicles (drones) in out-of-hospital-cardiac-arrest. Scand J Trauma Resusc Emerg Med 2016; 24: 124 DOI: 10.1186/s13049-016-0313-5.
• 17 Herlitz J, Svensson L, Engdahl J. et al. Characteristics of cardiac arrest and resuscitation by age group: an analysis from the Swedish Cardiac Arrest Registry. Am J Emerg Med 2007; 25: 1025-1031 DOI: 10.1016/j.ajem.2007.03.008.
• 18 Aune S, Herlitz J, Bång A. Characteristics of patients who die in hospital with no attempt at resuscitation. Resuscitation 2005; 65: 291-299 DOI: 10.1016/j.resuscitation.2004.11.028.
• 19 van Delden JJM, Löfmark R, Deliens L. et al. Do-not-resuscitate decisions in six European countries*. Crit Care Med 2006; 34: 1686-1690 DOI: 10.1097/01.ccm.0000218417.51292.a7.
• 20 Pearse RM, Moreno RP, Bauer P. et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet 2012; 380: 1059-1065 DOI: 10.1016/S0140-6736(12)61148-9.
• 21 Schwendimann R, Blatter C, Dhaini S. et al. The occurrence, types, consequences and preventability of in-hospital adverse events – a scoping review. BMC Health Serv Res 2018; 18: 521 DOI: 10.1186/s12913-018-3335-z.
• 22 Greif R, Bhanji F, Bigham BL. et al. Education, implementation, and teams: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 2020; 156: A188-A239 DOI: 10.1016/j.resuscitation.2020.09.014.
• 23 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 4: Advanced life support. Resuscitation 2005; 67: 213-247 DOI: 10.1016/j.resuscitation.2005.09.018.
• 24 Maharaj R, Raffaele I, Wendon J. Rapid response systems: a systematic review and meta-analysis. Crit Care 2015; 19: 254 DOI: 10.1186/s13054-015-0973-y.
• 25 Bergum D, Nordseth T, Mjølstad OC. et al. Causes of in-hospital cardiac arrest – incidences and rate of recognition. Resuscitation 2015; 87: 63-68 DOI: 10.1016/j.resuscitation.2014.11.007.
• 26 Adielsson A, Karlsson T, Aune S. et al. A 20-year perspective of in hospital cardiac arrest. Int J Cardiol 2016; 216: 194-199 DOI: 10.1016/j.ijcard.2016.04.013.
• 27 Herlitz J, Aune S, Bång A. et al. Very high survival among patients defibrillated at an early stage after in-hospital ventricular fibrillation on wards with and without monitoring facilities. Resuscitation 2005; 66: 159-166 DOI: 10.1016/j.resuscitation.2005.03.018.
• 28 Geddes LA, Roeder RA, Kemeny A. et al. The duration of ventricular fibrillation required to produce pulseless electrical activity. Am J Emerg Med 2005; 23: 138-141 DOI: 10.1016/j.ajem.2004.03.003.
• 29 Scarpino M, Lolli F, Lanzo G. et al. Neurophysiology and neuroimaging accurately predict poor neurological outcome within 24 hours after cardiac arrest: The ProNeCA prospective multicentre prognostication study. Resuscitation 2019; 143: 115-123 DOI: 10.1016/j.resuscitation.2019.07.032.
• 30 Lilja G, Nilsson G, Nielsen N. et al. Anxiety and depression among out-of-hospital cardiac arrest survivors. Resuscitation 2015; 97: 68-75 DOI: 10.1016/j.resuscitation.2015.09.389.
• 31 Moulaert VRM, van Heugten CM, Gorgels TPM. et al. Long-term Outcome After Survival of a Cardiac Arrest: A Prospective Longitudinal Cohort Study. Neurorehabili Neural Repair 2017; 31: 530-539 DOI: 10.1177/1545968317697032.
• 32 Baldi E, Vanini B, Savastano S. et al. Depression after a cardiac arrest: An unpredictable issue to always investigate for. Resuscitation 2018; 127: e10-e11 DOI: 10.1016/j.resuscitation.2018.03.027.
• 33 Mion M, Al-Janabi F, Islam S. et al. Care After resuscitation: Implementation of the United Kingdomʼs first dedicated multidisciplinary follow-up program for survivors of out-of-hospital cardiac arrest. Ther Hypotherm Temperat Manag 2020; 10: 53-59 DOI: 10.1089/ther.2018.0048.
• 34 Tiainen M, Vaahersalo J, Skrifvars MB. et al. Surviving out-of-hospital cardiac arrest: The neurological and functional outcome and health-related quality of life one year later. Resuscitation 2018; 129: 19-23 DOI: 10.1016/j.resuscitation.2018.05.011.
• 35 Israelsson J, Bremer A, Herlitz J. et al. Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender. Resuscitation 2017; 114: 27-33 DOI: 10.1016/j.resuscitation.2017.02.006.
• 36 Zimmerli M, Tisljar K, Balestra G-M. et al. Prevalence and risk factors for post-traumatic stress disorder in relatives of out-of-hospital cardiac arrest patients. Resuscitation 2014; 85: 801-808 DOI: 10.1016/j.resuscitation.2014.02.022.
• 37 Green CR, Botha JA, Tiruvoipati R. Cognitive function, quality of life and mental health in survivors of out-of-hospital cardiac arrest: a review. Anaesth Intens Care 2015; 43: 568-576 DOI: 10.1177/0310057x1504300504.
• 38 Lilja G, Nielsen N, Bro-Jeppesen J. et al. Return to work and participation in society after out-of-hospital cardiac arrest. Circ Cardiovasc Qual Outcomes 2018; 11 DOI: 10.1161/circoutcomes.117.003566.
• 39 Descatha A, Dumas F, Bougouin W. et al. Work factors associated with return to work in out-of-hospital cardiac arrest survivors. Resuscitation 2018; 128: 170-174 DOI: 10.1016/j.resuscitation.2018.05.021.
• 40 Nolan JP, Soar J, Cariou A. et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015. Resuscitation 2015; 95: 202-222 DOI: 10.1016/j.resuscitation.2015.07.018.
• 41 Semeraro F, Greif R, Böttiger BW. et al. Lebensrettende Systeme. Notfall Rettungsmed 2021; 24: 367-385 DOI: 10.1007/s10049-021-00889-7.
• 42 Olasveengen TM, Semeraro F, Ristagno G. et al. European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation 2021; 161: 98-114 DOI: 10.1016/j.resuscitation.2021.02.009.
• 43 Berdowski J, Blom MT, Bardai A. et al. Impact of onsite or dispatched automated external defibrillator use on survival after out-of-hospital cardiac arrest. Circulation 2011; 124: 2225-2232 DOI: 10.1161/circulationaha.110.015545.
• 44 Ringh M, Rosenqvist M, Hollenberg J. et al. Mobile-phone dispatch of laypersons for cpr in out-of-hospital cardiac arrest. N Engl J Med 2015; 372: 2316-2325 DOI: 10.1056/nejmoa1406038.
• 45 Kitamura T, Kiyohara K, Sakai T. et al. Public-access defibrillation and out-of-hospital cardiac arrest in Japan. N Engl J Med 2016; 375: 1649-1659 DOI: 10.1056/nejmsa1600011.
• 46 Valenzuela TD, Roe DJ, Nichol G. et al. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med 2000; 343: 1206-1209 DOI: 10.1056/NEJM200010263431701.
• 47 Søreide E, Morrison L, Hillman K. et al. The formula for survival in resuscitation. Resuscitation 2013; 84: 1487-1493 DOI: 10.1016/j.resuscitation.2013.07.020.
• 48 Chamberlain DA, Hazinski MF. Education in Resuscitation. Resuscitation 2003; 59: 11-43 DOI: 10.1016/j.resuscitation.2003.08.011.
• 49 Böttiger BW, Lockey A, Aickin R. et al. Over 675,000 lay people trained in cardiopulmonary resuscitation worldwide – The “World Restart a Heart (WRAH)” initiative 2018. Resuscitation 2019; 138: 15-17 DOI: 10.1016/j.resuscitation.2019.02.033.
• 50 Böttiger BW, Lockey A, Aickin R. et al. Up to 206 million people reached and over 5.4 million trained in cardiopulmonary resuscitation worldwide: the 2019 International Liaison Committee on Resuscitation World Restart a Heart Initiative. J Am Heart Assoc 2020; 9: e017230 DOI: 10.1161/JAHA.120.017230.
• 51 Cave DM, Aufderheide TP, Beeson J. et al. Importance and implementation of training in cardiopulmonary resuscitation and automated external defibrillation in schools. Circulation 2011; 123: 691-706 DOI: 10.1161/cir.0b013e31820b5328.
• 52 Baldi E, Savastano S, Contri E. et al. Mandatory cardiopulmonary resuscitation competencies for undergraduate healthcare students in Europe. Eur J Anaesthesiol 2020; 37: 839-841 DOI: 10.1097/eja.0000000000001272.
• 53 De Buck E, Van Remoortel H, Dieltjens T. et al. Evidence-based educational pathway for the integration of first aid training in school curricula. Resuscitation 2015; 94: 8-22 DOI: 10.1016/j.resuscitation.2015.06.008.
• 54 Soar J, Maconochie I, Wyckoff MH. et al. 2019 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 2019; 145: 95-150 DOI: 10.1016/j.resuscitation.2019.10.016.
• 55 Besnier E, Damm C, Jardel B. et al. Dispatcher-assisted cardiopulmonary resuscitation protocol improves diagnosis and resuscitation recommendations for out-of-hospital cardiac arrest. Emerg Med Australas 2015; 27: 590-596 DOI: 10.1111/1742-6723.12493.
• 56 Song KJ, Shin SD, Park CB. et al. Dispatcher-assisted bystander cardiopulmonary resuscitation in a metropolitan city: A before-after population-based study. Resuscitation 2014; 85: 34-41 DOI: 10.1016/j.resuscitation.2013.06.004.
• 57 Harjanto S, Na MXB, Hao Y. et al. A before-after interventional trial of dispatcher-assisted cardio-pulmonary resuscitation for out-of-hospital cardiac arrests in Singapore. Resuscitation 2016; 102: 85-93 DOI: 10.1016/j.resuscitation.2016.02.014.
• 58 Goto Y, Maeda T, Goto Y. Impact of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological outcomes in children with out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. J Am Heart Assoc 2014; 3: e000499-e000499 DOI: 10.1161/JAHA.113.000499.
• 59 Takahashi H, Sagisaka R, Natsume Y. et al. Does dispatcher-assisted CPR generate the same outcomes as spontaneously delivered bystander CPR in Japan?. Am J Emerg Med 2018; 36: 384-391 DOI: 10.1016/j.ajem.2017.08.034.
• 60 Hiltunen PVC, Silfvast TO, Jäntti TH. et al. Emergency dispatch process and patient outcome in bystander-witnessed out-of-hospital cardiac arrest with a shockable rhythm. Eur J Emerg Med 2015; 22: 266-272 DOI: 10.1097/MEJ.0000000000000151.
• 61 Olasveengen TM, de Caen AR, Mancini ME. et al. 2017 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations summary. Resuscitation 2017; 121: 201-214 DOI: 10.1016/j.resuscitation.2017.10.021.
• 62 Greif R, Lockey A, Breckwoldt J. et al. European Resuscitation Council Guidelines 2021: Education for resuscitation. Resuscitation 2021; 161: 388-407 DOI: 10.1016/j.resuscitation.2021.02.016.
• 63 Hattie J. Visible Learning: A Synthesis of over 800 Meta-analyses relating to Achievement. New York: Routledge; 2009
• 64 Hunziker S, Bühlmann C, Tschan F. et al. Brief eadership instructions improve cardiopulmonary resuscitation in a high-fidelity simulation: A randomized controlled trial*. Crit Care Med 2010; 38: 1086-1091 DOI: 10.1097/ccm.0b013e3181cf7383.
• 65 Norris EM, Lockey AS. Human factors in resuscitation teaching. Resuscitation 2012; 83: 423-427 DOI: 10.1016/j.resuscitation.2011.11.001.
• 66 Lockey A, Lin Y, Cheng A. Impact of adult advanced cardiac life support course participation on patient outcomes – A systematic review and meta-analysis. Resuscitation 2018; 129: 48-54 DOI: 10.1016/j.resuscitation.2018.05.034.
• 67 Lehmann R, Thiessen C, Frick B. et al. Improving pediatric basic life support performance through blended learning with web-based virtual patients: randomized controlled trial. J Med Internet Res 2015; 17: e162 DOI: 10.2196/jmir.4141.