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Frühdefibrillation in USA, Europa und Deutschland

Voraussetzungen, Erfahrungen, Perspektiven

First responder defibrillation in the US, in Europe or Germany—Prerequisits, experiences, perspectives

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Summary

Sudden out-of-hospital cardiac arrest is a leading cause of death and only 5–8% of patients survive such event. Defibrillation is the mose effective treatment and should performed within 5 minutes; however, its effectiveness diminishes with each passing minute. “Early defibrillation” is the use of automated external defibrillators (AEDs) by trained public-safety personnal (“first responder”), whereas “public access” defibrillation describes AED use by persons who have no specific AED training. Several studies in the US and in Europe show that first responder defibrillation will increase the number of survivors of out-of-hospital cardiac arrest compared to paramedics. This is caused by a shorter “call-to-arrival-time” in first responders compared to paramedics. In Europe, programs for the use of automated external defibrillators exist only occasionally. Reasons for this are the lack of open-mindedness, logistic and legal problems. In Germany, there are only few AED programs with promising results. At the present time, placement of automated external defibrillators in public places frequented by a large number of susceptible people will increase overall survival. However, placement of AEDs in all public places is still debatable and further studies are necessary to estimate the potential impact of publicc access defibrillators.

Zusammenfassung

Die Prognose von Patienten mit prähospitalem Herz-Kreislauf-Stillstand (pHKS) durch Kammerflimmern ist schlecht und nur 5–8% der Patienten überleben ein solches Ereignis. Die Defibrillation ist das entscheidende therapeutische Verfahren und sollte beim pHKS innerhalb von 5 Minuten erfolgen. Jede Minute, die vergeht, verschlechtert den Erfolg der Defibrillation. „Frühdefibrillation“ wird als Intervention mittels automatisierter externer Defibrillatoren (AED) durch nicht ärztliche Rettungskräfte verstanden, wobei zwischen der „First Responder“ Defibrillation (trainierte Laienhelfer) und der „Public Access“ Defibrillation (zufällig in der Nähe von AED anwesende untrainierte Laien) unterschieden wird. In den meisten bisher vorliegenden Studien aus USA und Europa wurde nachgewiesen, dass die AED-Anwendung durch trainierte Ersthelfer zu höheren Überlebensraten führte als beim Einsatz professioneller Helfer („NAW-Team“). Dieses wurde damit begründet, dass die „call-to-arrival-time“ bei Ersthelfern wesentlich kürzer war als bei den professionellen Rettungssystemen. In Europa gibt es nur vereinzelt AED-Programme, bedingt durch mangelnde Aufgeschlossenheit und organisatorische oder juristische Probleme. In Deutschland gibt es bisher nur relativ wenige Erfahrungen mit systematischen AED-Programmen; erste Erfolge sind aber auch hier vielversprechend. Nach den bisher vorliegenden Studien scheint die Installation von AEDs an den Orten sinnvoll zu sein, an denen sich viele Menschen aufhalten. Die Frage, ob und in welchen öffentlichen Gebäuden AEDs-Programme vorgehalten werden sollen, bleibt Gegenstand weiterer Untersuchungen.

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References

  1. Adult advanced cardiac life support (1992) JAMA 19:179–186

    Google Scholar 

  2. American Heart Association, International Liasion Committee on Resuscitation, ILCOR (2000) Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care—An international consensus on science. Circulation 102 (Suppl):1–384

    PubMed  Google Scholar 

  3. Becker L, Eisenberg M, Fahrenbruch C, Cobb L (1998) Public locations of cardiac arrest. Implication for public access defibrillation. Circulation 97:2106–2109

    CAS  PubMed  Google Scholar 

  4. Bunch TJ, White RD, Gersh BJ, Meverden RA, Hodge DO, Ballman KV, Hammill SC, Shen WK, Packer DL (2004) Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 348:2626–2633

    Google Scholar 

  5. Caffrey SL, Willoughby PJ, Pepe PE, Becker LB (2002) Public use of automated external defibrillators. N Engl J Med 347:1242–1247

    PubMed  Google Scholar 

  6. Capucci A, Aschieri D, Piepoli MF et al (2002) Tripling survival from sudden cardiac arrest via early defibrillation without traditional education in cardiopulmonary resuscitation. Circulation 106:1065–1070

    PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  8. Eisenberg MS, Hallstrom AP, Copass MK, Bergner L, Short F, Pierce J (1984) Treatment of ventricular fibrillation. Emergency medical technician defibrillation and paramedic services. JAMA 251:1723–1726

    CAS  PubMed  Google Scholar 

  9. Empfehlungen der Bundesärztekammer zur Defibrillation mit automatisierten externen Defibrillatoren (AED) durch Laien (2001) Dtsch Ärzteblatt 98:A 1211

  10. Foitik G, Hoerauf K (2003) Austrias nationwide public access defibrillation program: one year experience. Conference abstract of ERC Symposium on Early Defibrillation. 28.–29. 11. 2003

    Google Scholar 

  11. Frühdefibrillation durch medizinische Laien (2002) Dtsch Ärzteblatt 99:361

  12. Kellermann AL, Hackman BB, Somes G, Kreth TK, Nail L, Dobyns P (1993) Predicting the outcome of unsuccessful prehospital advanced cardiac life support. JAMA 270:1433–1436

    CAS  PubMed  Google Scholar 

  13. Mosesso VN, Davis EA, Auble TE, Paris PM, Yealy DM (1998) Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest. Ann Emerg Med 32:200–207

    PubMed  Google Scholar 

  14. Müller-Nordhorn J, Arntz HR, Löwel H, Willich SN (2001) Epidemiologie des plötzlichen Herztodes. Intensivmed 38:499–507

    Google Scholar 

  15. Myerburg RJ, Fenster J, Velez M, Rosenberg D, Lai S, Kurlansky P, Newton S, Knox M, Castellanos A (2002) Impact of community-wide police car deployment of automated external defibrillators on survival from out-ofhospital cardiac arrest. Circulation 106:1058–1064

    PubMed  Google Scholar 

  16. O’Rourke MF, Donaldson E, Geddes JS (1997) An airline cardiac arrest program. Circulation 96:2849–2853

    CAS  PubMed  Google Scholar 

  17. Page RL, Joglar JA, Kowal RC, Zagrodzky JD, Nelson LL, Ramaswamy K, Barbera SJ, Hamdan MH, McKenas DK (2000) Use of automated external defibrillators by a U.S. airline. N Engl J Med 343:1210–1216

    CAS  PubMed  Google Scholar 

  18. Peduzzi F, Jost, LePogann A, Degrange H, Rüttimann M (2003) Interest of automated external defibrillations implemented in public areas receiving crowd in an urban area. Conference abstract of ERC Symposium on Early Defibrillation, 28.–29.11. 2003

  19. Pell JP, Sirel JM, Marsden AK, Ford I, Walker NL, Cobbe SM (2002) Potential impact of public access defibrillators on survival after out of hospital cardiopulmonary arrest: retrospective cohort study. BMJ 325:1–5

    PubMed  Google Scholar 

  20. Priori SG, Bossaert LL, Chamberlain DA, Napolitano C, Arntz HR, Koster RW, Monsieurs KG, Capucci A, Wellens HJJ (2004) ESC-ERC recommendations for the use of automated external defibrillators (AEDs) in Europe. Eur Heart J 25:437–445

    PubMed  Google Scholar 

  21. Sefrin P (2004) Frühdefibrillation in Europa. Intensivmed 41:609–615

    Google Scholar 

  22. Statement of the Czech Resuscitation Group (2004) Public access defibrillation 2nd work meeting, Brno

  23. Stiell IG, Wells GA, Field B, Spaite DW, Nesbitt LP, De Maio V, Nichol G, Cousineau D, Blackburn J, Munkley D, Luinstra-Toohey L, Campeau T, Dagnone E, Lyver M, for the Ontario Prehospital Advance Life Support Study Group (2004) Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med 351:647–656

    Article  CAS  PubMed  Google Scholar 

  24. The Public Access Defibrillation Trial Investigators (2004) Public-Access-Defibrillation and survival after out-of-hospital cardiac arrest (PAD trial). N Engl J Med 351:637–646

    CAS  PubMed  Google Scholar 

  25. Trappe HJ (2001) Tachykarde Herzrhythmusstörungen. Notfall & Rettungsmedizin 4:235–245

    Google Scholar 

  26. Van Alem AP, Vrenken RH, Tijssen JGP, Koster RW (2003) Use of automated external defibrillator by first responders in out of hospital cardiac arrest: prospective controlled trials. Brit J Med 327:1312–1317

    Google Scholar 

  27. Venezuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman RG (2000) Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med 343:1206–1209

    CAS  PubMed  Google Scholar 

  28. Voelkel WG, Luger Th (2002) Frühdefibrillation in alpinen Wintersportregionen am Beispiel Stubaier Gletscher. http://www.arcs.ac.at/dissb/ru036600

  29. Weaver WD, Copass MK, Hill DL et al (1986) Cardiac arrest treated with a new automatic external defibrillator by out-of-hospital first responders. Am J Cardiol 57:1017–1021

    CAS  PubMed  Google Scholar 

  30. Weaver WD, Hill D, Fahrenbruch CE, Copass MK, Martin JS, Cobb LA, Hallstrom AP (1988) Use of the automatic external defibrillator in the management of out-of- hospital cardiac arrest. N Engl J Med 319:661–666

    CAS  PubMed  Google Scholar 

  31. Wellens HJJ, Brugada P (1987) Sudden cardiac death: a multifactorial problem. In: Brugada P, Wellens HJJ (Hrsg) Cardiac arrhythmias. Where to go from here? Futura, Mount Kisco New York, pp 391–400

  32. White RD, Asplin BR, Bugliosi TF, Hankins DG (1996) High discharge survival rate after out-of-hospital ventricular fibrillation with rapid defibrillation by police and paramedics. Ann Emerg Med 28:480–485

    CAS  PubMed  Google Scholar 

  33. White RD, Hankins DG, Atkinson EJ (2001) Patient outcomes following defibrillation with a low energy biphasic truncated exponential waveform in out-of-hospital cardiac arrest. Resuscitation 49:9–14

    CAS  PubMed  Google Scholar 

  34. White RD, Hankins DG, Bugliosi TF (1998) Seven years’ experience with early defibrillation by police and paramedics in an emergency medical services system. Resuscitation 39:145–151

    CAS  PubMed  Google Scholar 

  35. White RD (2001) Technological advances and program initiatives in public access defibrillation using automated external defibrillators. Curr Opin Crit Care 7:145–151

    CAS  PubMed  Google Scholar 

  36. Zheng ZJ, Croft JB, Giles WH, Mensah GH (2001) Sudden cardiac death in the United States, 1989 to 1998. Circulation 104:2158–2163

    CAS  PubMed  Google Scholar 

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  1. Medizinische Klinik II (Schwerpunkte Kardiologie und Angiologie), Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany

    H.-J. Trappe

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Trappe, HJ. Frühdefibrillation in USA, Europa und Deutschland. Herzschr. Elektrophys. 16, 94–102 (2005). https://doi.org/10.1007/s00399-005-0463-z

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  • DOI: https://doi.org/10.1007/s00399-005-0463-z

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