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DOI: 10.1055/s-0033-1357929
Postreanimationsbehandlung
Teil 2Publication History
Publication Date:
10 June 2014 (online)
![](https://www.thieme-connect.de/media/notfall-u2d/201402/lookinside/thumbnails/10.1055-s-0033-1357929-1.jpg)
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Die besten Behandlungsergebnisse nach kardiopulmonaler und zerebraler Reanimation lassen sich nur erzielen, wenn die Behandlung alle Glieder der Überlebenskette gleichermaßen berücksichtigt. In den ERC-Leitlinien 2005 und 2010 ist die Postreanimationsbehandlung fester Bestandteil der Empfehlungen geworden.
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Mittlerweile ist die Postreanimationskrankheit gut definiert und in vielen Details verstanden. Es ergeben sich eine Vielzahl von therapeutischen Interventionen für die Krankenhausteams, welche – früh und zielgerichtet umgesetzt – die Überlebenswahrscheinlichkeit der Patienten signifikant und relevant verbessern.
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Die therapeutischen Bemühungen zielen auf die Minimierung eines sekundären Hirnschadens ab.
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Eine therapeutische Hypothermie wird präklinisch durch den Notarzt begonnen und im Krankenhaus fortgeführt. Anzustreben ist eine Temperatur von 32–34 °C, die für mindestens 24 Stunden aufrechterhalten wird. Die Wiedererwärmung erfolgt je nach verwendetem Gerät aktiv oder passiv, stets aber sehr langsam.
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Des Weiteren gilt es, zielgerichtet und schnell eine hämodynamische Stabilisierung zu erreichen. Komatöse Patienten werden intubiert und beatmet. Hyperthermien sind zu vermeiden.
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Aktuelle Untersuchungen zeigen, dass dieser umfassende Therapieansatz, wenn er standardisiert umgesetzt wird, die Prognose der Patienten signifikant verbessert [50]–[53].
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Mittlerweile ist zu fordern, dass Patienten nach CPR in ein Reanimationszentrum – entsprechend den Traumazentren – transportiert werden sollten, das PCI und Hypothermiebehandlung gemäß einem lokalen Standard 24 Stunden am Tag und 7 Tage die Woche vorhält [50], [51], [54], [55].
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