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Verbessertes Überleben durch leitliniengerechte kardiopulmonale Reanimation

Analyse der primären Überlebensrate im Hamburger Rettungsdienst

Improved survival by guideline compliant cardiopulmonary resuscitation

Analysis of primary survival rates in the Hamburg emergency medical service

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Zusammenfassung

Hintergrund

Für die Durchführung einer kardiopulmonalen Reanimation (CPR) liegen international abgestimmte Leitlinien vor. Bis Ende 2005 waren für Europa die Leitlinien 2000 des European Resuscitation Council gültig, anschließend die Leitlinien 2005. Ziel der vorliegenden Studie war es, die Qualität der präklinischen CPR durch Rettungsassistenten im Hinblick auf die Einhaltung der geltenden Leitlinien zu analysieren.

Patienten und Methoden

Es wurden 299 Reanimationen im Hamburger Rettungsdienst zwischen dem 01.11.2004 und dem 31.12.2007 ausgewertet. Anhand der digitalen Aufzeichnungen der automatisierten externen Defibrillatoren (AED) sowie der CPR-Protokolle der Rettungsassistenten wurden die Daten hinsichtlich verschiedener Zeiten (u. a. CPR-Dauer, Dauer bis zur Wiederkehr eines organisierten EKG-Rhythmus, bis zur ersten Analyse bzw. Schockabgabe, Zeitabstände zwischen den Analysen bzw. Schockabgaben) und weiterer Daten wie EKG-Rhythmus und primäres Überleben bis zur Krankenhausaufnahme analysiert und das Einhalten der Leitlinien beurteilt.

Ergebnisse

Von den ausgewerteten 299 Reanimationen wurden 197 (65,9%) nach den Leitlinien 2000 und 102 (34,1%) nach den Leitlinien 2005 durchgeführt. „Return of spontaneous circulation“ (ROSC) konnte in 164 Fällen (54,8%), ein Überleben bis zur Krankenhausaufnahme in 125 Fällen (41,8%) erreicht werden. Bezüglich der primären Überlebensrate gab es keinen signifikanten Unterschied zwischen der CPR nach den Leitlinien 2000 und den Leitlinien 2005 (40,1 vs. 45,1%). In 273 der 299 Reanimationen (91,3%) wurden die Leitlinien nicht vollständig eingehalten. Das Einhalten der Leitlinien führte zu einer – auch unabhängig von der CPR-Dauer – signifikant vergrößerten primären Überlebensrate (73,1 vs. 38,8%, p=0,007).

Schlussfolgerung

Nach den vorgestellten Daten werden die Leitlinien nur selten vollständig eingehalten. Das Einhalten der CPR-Leitlinien sollte unbedingt angestrebt werden, da hierdurch die Sterberate um 71,9% reduziert werden kann. Zukünftige wissenschaftliche Untersuchungen sollten klären, wie das Einhalten der Leitlinien in der präklinischen Notfallversorgung verbessert werden kann.

Abstract

Background

In 2005 revised guidelines for cardiopulmonary resuscitation (CPR) were published by the European Resuscitation Council replacing the guidelines implemented in the year 2000. The aim of this study was to test the compliance with valid guidelines and to establish the quality of pre-hospital CPR provided by paramedics over a period of 38 months.

Patients and methods

A total of 299 CPRs performed by paramedics of the emergency medical services of Hamburg, Germany between 1st November 2004 and 31st December 2007 were analyzed. Digital recordings of automated external defibrillators and emergency protocol data were analyzed in detail. CPR was judged as incorrect if the defibrillation energy level did not correspond to the valid guidelines or if the interval between defibrillations exceeded a tolerance range of more than 30% compared to the valid guidelines.

Results

All CPRs (299) were included in the analysis of which 197 (65.9%) were intended to follow the 2000 guidelines and 102 (34.1%) the 2005 guidelines. Return of spontaneous circulation (ROSC) was achieved in 164 cases (54.8%) and survival to hospital admission in 125 cases (41.8%). CPR was performed accurately according to guidelines in only 26 cases (8.7%). In 273 cases (91.3%) the guidelines were not followed completely. Concerning the translation of guidelines into practice most faults occurred due to wrong intervals (89.3%), wrong defibrillation energy (33.4%) and medical errors, such as defibrillating an asystolic patient (7.0%). Primary survival rates were not significantly different when CPR accurately followed the 2000 or 2005 guidelines (40.1% versus 45.1%). Comparing primary survival rates of cases in which the guidelines were followed completely, there was no significant difference between the 2000 guidelines (15 out of 21 cases 71.4%) and 2005 guidelines (4 out of 5 cases 80.0%). However, compliance with valid guidelines significantly increased primary survival rates compared to non-compliance with valid guidelines (19 out of 26 cases 73.1% versus 106 out of 273 cases 38.8%; p=0.007). This effect was independent of the duration of CPR.

Comparing CPR with monophasic defibrillation (189 cases) or biphasic defibrillation (58 cases), there was a significantly higher rate of ROSC (56.1% versus 72.4%) and a significantly higher rate of primary survival (41.3% versus 56.9%) in favour of biphasic defibrillation.

Conclusion

The results of our study show that compliance with valid guidelines is low and furthermore suggest that compliance with guidelines significantly reduces mortality. Future research may be warranted into the question of how to increase compliance with current CPR guidelines in pre-hospital emergency care.

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Literatur

  1. Abella BS, Alvardo JP, Myklebust H et al (2005) Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA 293:305–310

    Article  CAS  PubMed  Google Scholar 

  2. Abella BS, Sandbo N, Vassilatos P et al (2005) Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest. Circulation 111:428–434

    Article  PubMed  Google Scholar 

  3. Aufderheide TP, Sigurdsson G, Pirallo RG et al (2004) Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation 109:1960–1965

    Article  PubMed  Google Scholar 

  4. Dirks B, Sefrin P (2006) Reanimation 2006. Empfehlungen der Bundesärztekammer nach den Leitlinien des European Resuscitation Council. Dtsch Arztebl 103:A2263–A2267

    Google Scholar 

  5. Eisenberg MS, Mengert TJ (2001) Cardiac resuscitation. N Engl J Med 344:1304–1313

    Article  CAS  PubMed  Google Scholar 

  6. European Resuscitation Council (2000) Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. An international consensus on science. Resuscitation 46(1–3):1–448

    Google Scholar 

  7. European Resuscitation Council (2005) Guidelines for Resuscitation 2005. Resuscitation 67S1:S1–S189

    Google Scholar 

  8. Gallagher EJ, Lombardi G, Gennis P (1995) Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest. JAMA 274:1922–1925

    Article  CAS  PubMed  Google Scholar 

  9. Jacobs I, Nadkarni V, and the ILCOR task force on cardiac arrest and cardiopulmonary resuscitation outcomes (2004) Cardiac arrest and cardiopulmonary resuscitation outcome reports: update and simplification of the Utstein templates for resuscitation registries. Circulation 110:3385–3397

    Article  PubMed  Google Scholar 

  10. Knobelsdorff G von, Reiferscheid F, Straakholder TM, Wirtz S (2004) Wird der Algorithmus des European Resuscitation Council zur kardiopulmonalen Reanimation eingehalten? Intensivmedizin 41:22–28

    Article  Google Scholar 

  11. Kudenchuk PJ, Cobb LA, Copass MK et al (2006) Transthoracic incremental monophasic vs. biphasic defibrillation by emergency responders (TIMBER). A randomized comparison of monophasic with biphasic waveform ascending energy defibrillation for the resuscitation of out-of-hospital cardiac arrest due to ventricular fibrillation. Circulation 114:2010–2018

    Article  PubMed  Google Scholar 

  12. Lischke V, Kessler P, Byhahn C et al (2004) Die transthorakale Defibrillation. Physiologische und pathophysiologische Grundlagen und deren Bedeutung für den Reanimationserfolg. Anaesthesist 53:125–136

    Article  CAS  PubMed  Google Scholar 

  13. Morrison LJ, Dorian P, Long J et al (2005) Out of hospital cardiac arrest rectilinear biphasic or monophasic damped sine defibrillation waveforms with advanced life support intervention trial (ORBIT). Resuscitation 66:149–157

    Article  PubMed  Google Scholar 

  14. Olasveengen TM, Wik L, Kramer-Johansen J et al (2007) Is CPR quality improving? A retrospective study of out-of-hospital cardiac arrest. Resuscitation 75:260–266

    Article  PubMed  Google Scholar 

  15. Olasveengen TM, Vik E, Kuzovlev A, Sunde K (2009) Effect of implementation of new resuscitation guidelines on quality of cardiopulmonary resuscitation and survival. Resuscitation 80:407–411

    Article  PubMed  Google Scholar 

  16. Rea TD, Crouthamel M, Eisenberg MS et al (2003) Temporal patterns in long-term survival after resuscitation from out-of-hospital cardiac arrest. Circulation 108:1196–1201

    Article  PubMed  Google Scholar 

  17. Rea TD, Helbock M, Perry S et al (2006) Increasing use of cardiopulmonary resuscitation during out-of-hospital ventricular fibrillation arrest. Survival implications of guidelines changes. Circulation 114:2760–2765

    Article  PubMed  Google Scholar 

  18. Sayre MR, Cantrell SA, White LJ et al (2009) Impact of the 2005 American Heart Association cardiopulmonary resuscitation and emergency cardiovascular care guidelines on out-of-hospital cardiac arrest survival. Prehosp Emerg Care 13:469–477

    Article  PubMed  Google Scholar 

  19. Schneider T, Martens PR, Paschen H et al (2000) Multicenter, randomized, controlled trial of 150-J biphasic shocks compared with 200- to 360-J monophasic shocks in the resuscitation of out-of-hospital cardiac arrest victims. Optimized Response to Cardiac Arrest (ORCA) Investigators. Circulation 102:1780–1787

    CAS  PubMed  Google Scholar 

  20. Steinmetz J, Barnung S, Nielsen SL et al (2008) Improved survival after an out-of-hospital cardiac arrest using new guidelines. Acta Anaesthesiol Scand 52:908–913

    Article  CAS  PubMed  Google Scholar 

  21. Alem AP van, Chapman FW, Lank P et al (2003) A prospective, randomised and blinded comparison of first shock success of monophasic and biphasic waveforms in out-of-hospital cardiac arrest. Resuscitation 58:17–24

    Article  PubMed  Google Scholar 

  22. Hoeyweghen RJ van, Bossaert LL, Mullie A et al (1993) Quality and efficiency of bystander CPR. Belgian cerebral resuscitation study group. Resuscitation 26:47–52

    Article  PubMed  Google Scholar 

  23. Wenzel V, Voelckel WG, Krismer AC et al (2001) Die neuen internationalen Richtlinien zur kardiopulmonalen Reanimation. Eine Analyse und Kommentierung der wichtigsten Änderungen. Anaesthesist 50:342–357

    Article  CAS  PubMed  Google Scholar 

  24. Wenzel V, Russo S, Arntz HR et al (2006) Die neuen Reanimationsleitlinien 2005 des European Resuscitation Council. Kommentar und Ergänzungen. Anaesthesist 55:958–979

    Article  CAS  PubMed  Google Scholar 

  25. Wik L, Steen PA, Bircher NG (1994) Quality of bystander cardiopulmonary resuscitation influences outcome after prehospital cardiac arrest. Resuscitation 28:195–203

    Article  CAS  PubMed  Google Scholar 

  26. Wik L, Kramer-Johansen J, Myklebust H et al (2005) Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA 293:299–304

    Article  CAS  PubMed  Google Scholar 

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Danksagung

Wir bedanken uns bei Frau Dr. Christine Gräfin zu Eulenburg vom Institut für Medizinische Biometrie und Epidemiologie (Direktor Prof. Dr. rer. pol. K. Wegscheider) für die Beratung bei der statistischen Auswertung.

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Authors and Affiliations

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

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

  2. Ärztlicher Leiter Rettungsdienst der Feuerwehr Hamburg, Feuerwehr Hamburg, Hamburg, Deutschland

    S. Oppermann

  3. Klinik für Anästhesiologie, Operative Intensivmedizin und Schmerztherapie, Klinikum Bogenhausen, München, Deutschland

    P. Friederich

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  1. S. Maisch
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  2. A. Krüger
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Correspondence to S. Maisch.

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Maisch, S., Krüger, A., Oppermann, S. et al. Verbessertes Überleben durch leitliniengerechte kardiopulmonale Reanimation. Anaesthesist 59, 994–1002 (2010). https://doi.org/10.1007/s00101-010-1766-y

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