European Resuscitation Council - Leitlinien für die Wiederbelebung 2005

Einleitung

Diese Darstellung legt die Leitlinien zur Defibrillation mit so genannten automatisierten externen Defibrillatoren (AED) und mit manuellen Defibrillatoren dar. Medizinisches Personal und auch Laienhelfer sind in der Lage, AEDs als einen integralen Bestandteil der Basisreanimation anzuwenden. Im Rahmen der erweiterten Wiederbelebung ist die manuelle Defibrillation Teil der Behandlung. Da bei vielen Defibrillatoren die synchronisierte Kardioversion und die Schrittmachertherapie (Pacing) zu den Grundfunktionen gehören, wird beides ebenfalls in diesem Kapitel abgehandelt.

Unter Defibrillation versteht man den Durchgang einer Strommenge durch das Myokard, die ausreicht, eine kritische Myokardmasse zu depolarisieren, und dadurch die Wiederherstellung einer geordneten elektrischen Aktivität ermöglicht. Die Defibrillation wird als Beendigung des Flimmerns definiert, oder - genauer gesagt - als das Fehlen von VF/VT 5 s nach der Abgabe des elektrischen Schocks; das Ziel einer Defibrillation ist die Wiederherstellung eines spontanen Kreislaufes.

Die Technologie der Defibrillatoren schreitet rasch voran. Bei den AEDs ist die Interaktion mit dem Retter mit Hilfe von gesprochenen Anweisungen eingeführt. Die weitere Entwicklung könnte noch genauere Anweisungen ermöglichen. Die Erkennung des Rhythmus unter laufender Wiederbelebung durch die Defibrillatoren ist erforderlich, um unnötige Verzögerungen bei den Wiederbelebungsmaßnahmen zu vermeiden. Die Auswertung der Flimmercharakteristik könnte es ermöglichen, den optimalen Zeitpunkt zu ermitteln, an dem ein Schock abgegeben werden sollte.

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