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Kardiopulmonale Reanimation „oben ohne“

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“Topless” cardiopulmonary resuscitation

Fashion or science?

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Zusammenfassung

Eine Dekade nach Beginn der Diskussion, ob die Beatmung durch Laienreanimation in den ersten Minuten verzichtbar sei, wird der Informationsstand zum Thema aktualisiert und kommentiert. Tierexperimente und eine prospektive randomisierte Patientenstudie hatten zunächst nahe gelegt, dass eine Beatmung unter diesen Umständen ohne Folgen für das individuelle Outcome unterbleiben könne. Die Analyse der neueren Literatur jedoch zeigt, dass Thoraxkompressionen ohne Beatmung der standardmäßigen kardiopulmonalen Reanimation („cardiopulmonary resuscitation“, CPR) in keinem Fall überlegen sind, und nur in sehr speziellen Szenarien gleichwertig sein könnten. Anstatt bewährte Bausteine der „Basic-life-support-“ (BLS-) Ausbildung und -Praxis in Frage zu stellen, sollte eine weitere Verbesserung der Ausbildung von Laien und professionellen Rettern angestrebt werden, sowie die durch Leitstellenpersonal geführte Telefon-CPR evaluiert und, bei Nachweis einer Verbesserung des Outcomes, diese auch forciert eingesetzt werden. Zukünftige Studien sollten sich weniger auf die Abschaffung als auf die Optimierung der Beatmung unter den spezifischen Bedingungen der CPR konzentrieren.

Abstract

A decade after the onset of a discussion whether ventilation could be omitted from bystander basic life support (BLS) algorithms, the state of the evidence is reevaluated. Initial animal studies and a prospective randomized patient trial had suggested that omission of ventilation during the first minutes of lay cardiopulmonary resuscitation (CPR) did not impair patient outcomes. More recent studies demonstrate, however, that this may hold true only in very specific scenarios, and that the chest compression-only technique was never superior to standard BLS. Instead of calling basics of BLS training and practice into question, more and better training of lay persons and professionals appears mandatory, and targeted use of dispatcher-guided telephone CPR should be evaluated and, if it improves outcome, it should be encouraged. Future studies should focus much less on the omission but on the optimization of ventilation under the specific conditions of CPR.

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Authors and Affiliations

  1. Klinik und Poliklinik für Anästhesiologie, Inselspital, Universität Bern, Bern, Schweiz

    K. Markstaller & B. Eberle

  2. Klinik für Anästhesiologie, Johannes Gutenberg-Universität, Mainz, Deutschland

    K. Markstaller & W. F. Dick

  3. Klinik und Poliklink für Anästhesiologie, Inselspital, Universität Bern, 3010, Bern, Schweiz

    K. Markstaller

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  1. K. Markstaller
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  2. B. Eberle
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Correspondence to K. Markstaller.

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Markstaller, K., Eberle, B. & Dick, W.F. Kardiopulmonale Reanimation „oben ohne“. Anaesthesist 53, 927–936 (2004). https://doi.org/10.1007/s00101-004-0749-2

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