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Vom Angelausflug auf die Intensivstation

Erfolgreiche Reanimation nach einem Ertrinkungsunfall

From fishing trip to the critical care unit

Successful resuscitation after a near drowning accident

  • Kasuistiken
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Zusammenfassung

Hintergrund

Auch im Rahmen der Leitlinien des European Resuscitation Council (ERC) ergeben sich gemäß unterschiedlichen Rahmenbedingungen Modifikationen der vorgeschlagenen Algorithmen. Hierbei gehen wesentliche für den Herz-Kreislauf-Stillstand mitverantwortliche Faktoren in die Therapieentscheidung ein. Die vorliegende Kasuistik thematisiert die Spezifikationen im Rahmen der Hypothermie.

Kasuistik

Der Patient wurde nach Beinahe-Ertrinken mit schwerer Hypothermie (ca. 30 min unter Wasser) initial ohne Spontankreislauf geborgen. Bei rasch erfolgendem Wiedereinsetzen eines spontanen Kreislaufs („return of spontaneous circulation“, ROSC) konnte er an Tag 15 im Anschluss an den Unfall ohne fokal-neurologische Defizite in die Rehabilitation entlassen werden.

Diskussion

Die Sektion 8 des ERC hat Ergänzungen zu den ERC-Leitlinien bei Reanimation unter besonderen Umständen formuliert, die im vorliegenden Fall große Relevanz hatten. Ein wichtiges Kriterium stellte hier die Hypothermie dar, die eine angepasste Pharmakotherapie notwendig machte. Weiterhin war die Wahl des Zielkrankenhauses aus rettungsdienstlicher Sicht maßgeblich, um die Hypothermie und die sich daraus ergebenden Komplikationen adäquat mithilfe kontrollierter Wiedererwärmung therapieren zu können.

Abstract

Background

In the context of the European Resuscitation Council (ERC) guidelines, modifications of the proposed treatment algorithm need to be performed in order to respond to different parameters. In this respect several factors interacting with cardiac arrest are essential and need to be included in the therapy. This case report demonstrates an example of resuscitation in the situation of hypothermia.

Case report

After a near drowning accident and approximately 30 min underwater, a patient suffering from severe hypothermia initially required resuscitation after the rescue. A return of spontaneous circulation (ROSC) was successfully achieved within a short length of time and after 15 days on the intensive care unit the patient was discharged to a rehabilitation facility without any signs of focal neurological deficits.

Discussion

Section 8 of the ERC guidelines provides additional information for resuscitation under specific conditions. In this case report, hypothermia was one of the main criteria leading to an adjusted pharmacological therapy. Furthermore, selection of the appropriate hospital for an optimal advanced treatment including controlled warming of the patient and management of hypothermia-induced complications had to be evaluated.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Kippnich, D. Keller, J. Jokinen, C. Kilgenstein, R.M. Muellenbach, C. Markus, N. Roewer und P. Kranke geben an, dass kein Interessenkonflikt besteht. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Fall von nichtmündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland

    M. Kippnich, D. Keller, J. Jokinen, C. Kilgenstein, R.M. Muellenbach, C. Markus, N. Roewer &  P. Kranke MBA

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  1. M. Kippnich
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  2. D. Keller
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  3. J. Jokinen
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  4. C. Kilgenstein
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  5. R.M. Muellenbach
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  6. C. Markus
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  7. N. Roewer
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  8. P. Kranke MBA
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Corresponding author

Correspondence to P. Kranke MBA.

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Kippnich, M., Keller, D., Jokinen, J. et al. Vom Angelausflug auf die Intensivstation. Anaesthesist 63, 839–843 (2014). https://doi.org/10.1007/s00101-014-2382-z

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  • DOI: https://doi.org/10.1007/s00101-014-2382-z

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