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„Public access defibrillation“

Beschränkungen des Einsatzes durch ausgebildete Ersthelfer und Laien

Public access defibrillation

Limited use by trained first responders and laymen

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Zusammenfassung

Aufgrund des Kammerflimmerns als häufigstem initialen Herzrhythmus bei einem außerklinischen Kreislaufstillstand ist die Defibrillation von wesentlicher Bedeutung. Seit einigen Jahren stehen automatisierte externe Defibrillatoren (AED) zur Verfügung, die eine Defibrillation auch durch andere Personengruppen als Ärzte und medizinisches Fachpersonal, wie ausgebildete Ersthelfer und Laien, ermöglichen. Diese „public access defibrillation“ führte zu der Hoffnung auf einen großen Fortschritt im Kampf gegen den plötzlichen Herztod. Allerdings bestehen zahlreiche Limitationen dieses Konzeptes, wie die geringe Häufigkeit des plötzlichen Herztodes in der Öffentlichkeit, die seltene Anwendung von öffentlich platzierten AED, die geringe Kosteneffektivität, die kritische rechtliche Situation und die unzureichende Hilfsbereitschaft der Bevölkerung. Aufgrund dieser Einschränkungen sind andere Maßnahmen erfolgversprechender als die Bestrebungen, AED ubiquitär zu verbreiten. Zu diesen Maßnahmen zählen u. a. die Primär- oder Sekundärprophylaxe des plötzlichen Herztodes, die allgemeine Vermittlung der korrekten Aktivierung des Rettungsdienstes, die Implementierung von mit AED ausgestatteten „First-responder-Teams“ und insbesondere eine bessere Ausbildung der Bevölkerung in den Basismaßnahmen der kardiopulmonalen Reanimation.

Abstract

As ventricular fibrillation is the most frequent initial heart rhythm causing out-of-hospital sudden cardiac arrest, defibrillation is of essential significance. Automated external defibrillators (AEDs) have been available for some years and as a result defibrillation can be carried out by individuals other than physicians and healthcare providers such as trained first responders and untrained lay rescuers. This so-called public access defibrillation nourished hope of progress in the treatment of sudden cardiac arrest. However, several limitations exist, such as low frequency of sudden cardiac arrest in public, rare use of publicly placed AEDs, low cost effectiveness, legal requirements and insufficient public willingness to help. Due to these restrictions of public access defibrillation other measures are more promising than the attempt at general distribution of AEDs. These measures are primary or secondary prophylaxis of sudden cardiac arrest, general knowledge of adequate activation of emergency medical services, implementation of first responder teams equipped with AEDs and particularly a better education in and application of the well-established principles of cardiopulmonary resuscitation.

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  1. Klinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Deutschland

    S. Maisch, P. Friederich & A. E. Goetz

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Maisch, S., Friederich, P. & Goetz, A.E. „Public access defibrillation“. Anaesthesist 55, 1281–1290 (2006). https://doi.org/10.1007/s00101-006-1098-0

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