Abstract
Sudden cardiac death is a major challenge that we are still facing. The complexity of the trigger mechanisms makes it difficult to achieve a reliable identification of high-risk patients. Thus, three suggestions will be made that might be helpful to overcome this epidemic catastrophe “Sudden Cardiac Death”. 1) In patients with known heart disease risk stratification has to be improved by developing new methods to identify predominantly those individuals, who are at risk for sudden rather than non-sudden cardiac death. 2) The general population contains an unknown proportion of individuals with advanced coronary artery disease, which is commonly asymptomatic. In this so called “normal population” classical risk stratification does not work. However, since there is a close relationship between the prevalence of risk factors for coronary artery disease and sudden death, a consequent treatment of risk factors should have a positive impact on sudden death rate as well. 3) The success rate of resuscitation has to be improved by strengthening each single link of the “chain of survival”. Educated laypersons have to play a much larger role on this scene.
Zusammenfassung
Der plötzliche Herztod gehört seit vielen Jahren zu den häufigsten Todesursachen und stellt auch heute noch ein weitgehend ungelöstes Problem dar. Die Komplexität der Auslösemechanismen erschweren die Identifizierung des Risikopatienten und machen die Vorhersagbarkeit eines solchen Ereignisses unmöglich. Mögliche Lösungsansätze könnten sein:
1. Für Patienten mit bekannter Herzerkrankung (vor allem koronarer Herzerkrankung) gilt es die Methoden zur Risikostratifikation weiter zu verfeinern, um möglichst gezielt nur denjenigen eine effektive und dann auch kosteneffiziente Therapie (z. B. implantierbarer Defibrillator) zukommen zu lassen, die diese auch benötigen. 2. Da die Inzidenz des plötzlichen Herztodes eng mit der Inzidenz der koronaren Herzerkrankung einhergeht, sollten Programme zur Reduktion plötzlicher Todesfälle sich vor allem auf die Beeinflussung der koronaren Herzerkrankung und ihrer Risikofaktoren konzentrieren. 3. Wir benötigen bessere Reanimationsergebnisse. Es gilt daher, die einzelnen Glieder der Rettungskette zu verstärken. Die kurze Zeitschiene, in der erfolgreich Wiederbelebung möglich ist, rückt den Laienhelfer in das Zentrum der Rettungskaskade. Nur wenn es uns gelingt, großflächig Laien kompetent und nachhaltig in den Reanimationsablauf einzubinden, können wir zu Recht die Hoffnung haben, dass in Zukunft der plötzliche Herztod ein wenig von seinem Schrecken verlieren wird.
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Andresen, D. Epidemiologie des plötzlichen Herztodes. Intensivmed 44, 188–193 (2007). https://doi.org/10.1007/s00390-007-0800-z
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DOI: https://doi.org/10.1007/s00390-007-0800-z