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Notfall + Rettungsmedizin
Erschienen in: Notfall + Rettungsmedizin 7/2010

01.11.2010 | ERC-Leitlinien

Erweiterte Reanimationsmaßnahmen für Erwachsene („advanced life support“)

Sektion 4 der Leitlinien zur Reanimation 2010 des European Resuscitation Council

verfasst von: C.D. Deakin, J.P. Nolan, J. Soar, K. Sunde, R.W. Koster, G.B. Smith, G.D. Perkins

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 7/2010

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Auszug

Die wichtigsten Änderungen in den Leitlinien 2010 zum „advanced life support“ (ALS) des European Resuscitation Council (ERC) beinhalten:
  • Die Betonung der Wichtigkeit von nur kurz unterbrochenen, hochqualitativen Thoraxkompressionen während der gesamten ALS-Intervention: Thoraxkompressionen dürfen nur für ganz spezielle Interventionen kurz unterbrochen werden.
  • Die Hervorhebung der Verwendung von „Track-and-trigger“- (Frühwarn-)Systemen, um eine Verschlechterung des Patientenzustands zu erkennen und eine Behandlung zu ermöglichen, die einen innerklinischen Kreislaufstillstand vermeiden hilft.
  • Eine erhöhte Aufmerksamkeit wird auf Warnzeichen für ein mögliches Risiko eines präklinischen plötzlichen Herztods gelegt.
  • Die Empfehlung, beim vom Rettungsdienstpersonal nichtbeobachteten außerklinischen Kreislaufstillstand vor der Defibrillation für eine festgelegte Dauer Maßnahmen der kardiopulmonalen Reanimation („cardiopulmonary resuscitation“, CPR) durchzuführen, wird aufgehoben.
  • Die Fortsetzung der Thoraxkompressionen während der Ladephase der Defibrillation – um die Präschockpause zu minimieren.
  • Die Bedeutung des präkordialen Faustschlags wird abgeschwächt.
  • Die Durchführung von bis zu 3 schnell aufeinanderfolgenden Schocks bei Kammerflimmern („ventricular fibrillation“, VF) oder bei pulsloser ventrikulärer Tachykardie („ventricular tachycardia“, VT) nach Herzkatheterisierung oder in der unmittelbar postoperativen Phase nach einer Thorakotomie.
  • Die Verabreichung von Medikamenten über den Endotrachealtubus wird nicht mehr empfohlen. Ist ein intravenöser (i.v.-)Zugang nicht möglich, sollen die Medikamente intraossär (i.o.) verabreicht werden.
  • Bei Behandlung des durch VF/VT ausgelösten Kreislaufstillstands wird 1 mg Adrenalin nach dem dritten Schock verabreicht, sobald die Thoraxkompressionen wieder aufgenommen wurden, und danach alle 3–5 min während alternierender CPR-Zyklen. Ebenso werden 300 mg Amiodaron nach dem dritten Schock verabreicht.
  • Atropin wird während der Asystolie oder der pulslosen elektrischen Aktivität (PEA) nicht mehr routinemäßig empfohlen.
  • Die Bedeutung der frühen endotrachealen Intubation wird reduziert, außer sie wird – bei minimaler Unterbrechung der Thoraxkompressionen – von hochqualifiziertem Personal durchgeführt.
  • Verstärkte Betonung liegt auf der Verwendung der Kapnographie zur Bestätigung und kontinuierlichen Überwachung der Lage des Endotrachealtubus sowie der CPR-Qualität und um einen möglichst frühen Hinweis auf den Wiedereintritt eines Spontankreislaufs („return of spontaneous circulation“, ROSC) zu erhalten.
  • Die mögliche Bedeutung der Ultraschalluntersuchung während des ALS wird anerkannt.
  • Die Anerkennung eines möglichen Schadens durch Hyperoxämie nach ROSC ist erfolgt. Sobald der ROSC gesichert ist und zuverlässig die arterielle Sauerstoffsättigung (SaO2, durch Pulsoxymetrie und/oder arterielle Blutgasanalyse) überwacht werden kann, soll die SaO2 mithilfe der inspiratorischen Sauerstoffkonzentration (FIO2) auf 94–98% titriert werden.
  • Die Behandlung des „post-cardiac arrest syndrome“ wird ausführlich dargestellt und betont.
  • Die Anerkennung, dass die Einführung eines umfassenden und strukturierten Behandlungsprotokolls zur Reanimationsnachsorge das Überleben von Opfern eines Kreislaufstillstands nach ROSC verbessern kann, wird gefordert.
  • Eine verstärkte Bedeutung wird auf die Durchführung der primären perkutanen Koronarintervention (PCI) bei geeigneten, jedoch komatösen Patienten mit anhaltendem ROSC nach Kreislaufstillstand gelegt.
  • Revision der Empfehlungen für die Glucosekontrolle: Bei Erwachsenen mit anhaltendem ROSC nach Kreislaufstillstand sollen Blutglucosewerte von >10 mmol/l (>180 mg/dl) behandelt, eine Hypoglykämie muss jedoch vermieden werden.
  • Die Anwendung der therapeutischen Hypothermie bei komatösen Überlebenden eines Kreislaufstillstands mit defibrillierbarem sowie auch nichtdefibrillierbarem initialen Herzrhythmus wird empfohlen. Der niedrigere Evidenzlevel für den Nutzen nach einem Kreislaufstillstand mit nichtdefibrillierbaren Herzrhythmen wird anerkannt.
  • Anerkannt wird, dass viele der akzeptierten Prädiktoren eines schlechten Outcome bei komatösen Überlebenden eines Kreislaufstillstands unzuverlässig sind, insbesondere wenn der Patient mithilfe der therapeutischen Hypothermie behandelt wurde.
…
Vorheriger Artikel Elektrotherapie: automatisierte externe Defibrillatoren, Defibrillation, Kardioversion und Schrittmachertherapie
Nächster Artikel Initiales Management des akuten Koronarsyndroms
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Metadaten
Titel
Erweiterte Reanimationsmaßnahmen für Erwachsene („advanced life support“)
Sektion 4 der Leitlinien zur Reanimation 2010 des European Resuscitation Council
verfasst von
C.D. Deakin
J.P. Nolan
J. Soar
K. Sunde
R.W. Koster
G.B. Smith
G.D. Perkins
Publikationsdatum
01.11.2010
Verlag
Springer-Verlag
Erschienen in
Notfall + Rettungsmedizin / Ausgabe 7/2010
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI
https://doi.org/10.1007/s10049-010-1370-3

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