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Prähospitale Versorgung des akuten Koronarsyndroms durch Anästhesisten

Prospektiver Vergleich mit dem Versorgungsstandard durch Kardiologen

Prehospital care of acute coronary syndrome by anaesthetists

Prospective comparison with the care standards of cardiologists

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Zusammenfassung

Hintergrund

Die prähospitale Versorgung des akuten Koronarsyndroms (ACS) durch Anästhesisten und Kardiologen wird verglichen.

Methoden

An einem interdisziplinären Notarztstützpunkt wurden die Krankheitsverläufe von 599 Patienten mit vermutetem ACS prospektiv verfolgt. Die prähospitale Versorgung wurde der Nachbefundung des prähospitalen EKG und dem weiteren Krankheitsverlauf gegenübergestellt.

Ergebnisse

Im Fall eines „ST-Strecken-Hebungs-Infarkts“ (STEMI) stellten Anästhesisten in 84% ihrer Fälle die korrekte prähospitale Diagnose, Kardiologen in 94% (p=0,048). Falsch-positive Befunde ergaben sich bei Anästhesisten in 11% vs. 5% bei Kardiologen (p=0,31). Anästhesisten begleiteten 100% der Patienten mit instabiler Angina pectoris vs. 94% bei den Kardiologen (p=0,06). Schmerzfreiheit erreichten 82% der Patienten bei Anästhesisten vs. 73% bei Kardiologen (p=0,01). Die Mortalität bei Entlassung war für beide Patientengruppen identisch (8,2%).

Schlussfolgerung

An einem interdisziplinären Notarztstützpunkt weisen Kardiologen eine höhere prähospitale Diagnosesicherheit auf, während Anästhesisten höhere therapeutische Vorsicht zeigen. Die Patientenmortalität bleibt unbeeinflusst.

Abstract

Background

Prehospital treatment of acute coronary syndrome (ACS) by anaesthetists acting in physician staffed emergency medical service (EMS) was compared with that of the gold standard of cardiologists.

Methods

Prospectively 599 patients with assumed ACS were traced. Prehospital diagnosis and therapy were compared with re-evaluation of ECGs and diagnosis on hospital discharge.

Results

In the case of ST-segment elevating myocardial infarction (STEMI) anaesthetists diagnosed 84% of cases correctly and cardiologists in 94% (p=0.048). False positive diagnoses were given in 11% by anaesthetists versus 5% by cardiologists (p=0.31). Anaesthetists accompanied all patients with instable angina versus 94% by cardiologists (p=0.06). Anaesthetists achieved 82% of patients to be pain-free versus 73% of cardiologists (p=0.01). Mortality until discharge was identical for the two groups (8.2%).

Conclusion

In prehospital management of ACS cardiologists showed higher diagnostic competence, whereas anaesthetists revealed a greater degree of therapeutic caution. Patient mortality was not influenced.

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Authors and Affiliations

  1. Klinik für Anästhesiologie und operative Intensivmedizin, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    J. Breckwoldt & M. Overbeck

  2. Klinik für Kardiopulmologie, Charité, – Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland

    D. Müller, R. Stern, L. Schnitzer & H.R. Arntz

Authors
  1. J. Breckwoldt
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  2. D. Müller
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  3. M. Overbeck
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  4. R. Stern
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  5. L. Schnitzer
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  6. H.R. Arntz
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Correspondence to J. Breckwoldt.

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Breckwoldt, J., Müller, D., Overbeck, M. et al. Prähospitale Versorgung des akuten Koronarsyndroms durch Anästhesisten. Anaesthesist 57, 131–138 (2008). https://doi.org/10.1007/s00101-007-1290-x

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