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Innerklinische Notfallversorgung in Deutschland

Reanimationsteam oder Rapid-Response-System?

In-house emergency care in Germany

Resuscitation team or rapid response system?

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Zusammenfassung

Hintergrund

Innerklinische Reanimationen werden von speziellen Reanimationsteams durchgeführt, die Versorgung anderer Notfälle ist in deutschen Kliniken weniger stringent organisiert. Rapid-Response-Systeme mit definierten Alarmierungskriterien sind bislang kaum etabliert, Daten zur innerklinischen Notfallversorgung nur in geringem Umfang vorhanden.

Ziel der Arbeit

Charakterisierung der Einsätze von Reanimationsteams in deutschen Kliniken am Beispiel der Charité – Universitätsmedizin Berlin.

Material und Methoden

An der Charité, Campus Benjamin Franklin, wurden nach Einführung einer standardisierten Notfalldokumentation alle zwischen dem 01.10.2012 und dem 31.05.2016 registrierten Einsätze des internistischen Reanimationsteams retrospektiv mit der Frage nach Einsatzarten, Mortalität und Einsatzcharakteristika ausgewertet.

Ergebnisse

Bei 219 (44,1 %) von 497 Notfalleinsätzen lag ein auswertbares Notfalleinsatzprotokoll vor, davon waren 93 (42,5 %) keine Reanimationen, sondern andere Notfälle mit einer Krankenhaussterblichkeit von 24,7 % (vs. 63,8 % nach Reanimation, p < 0,001) und einer Intensivaufnahmerate von 68,5 %. Bei 32,3 % dieser Einsätze erfolgte die Alarmierung zunächst unter dem Stichwort „Reanimation“, die bei Eintreffen dokumentierten Vitalparameter lagen dann aber im Normbereich. Prognostisch relevant war ein niedriger Wert auf der Glasgow Coma Scale (4 vs. 14 Punkte, p = 0,006).

Schlussfolgerungen

Reanimationsteams versorgen häufig auch andere schwerwiegende innerklinische Notfälle. Die Etablierung von Rapid-Response-Systemen mit festgelegten Alarmierungskriterien erscheint daher auch für deutsche Kliniken sinnvoll.

Abstract

Background

In German hospitals in-house resuscitation is carried out by specialist teams but the response to other emergencies is less rigorously organized. So far few rapid response systems with predetermined activation criteria have been established. Only limited data are available on in-house emergency management.

Objective

Characterization of resuscitation team deployment in German hospitals exemplified by the Charité University Medicine Berlin.

Material and methods

Following the introduction of a standardized emergency documentation procedure at the Charité Campus Benjamin Franklin, all registered calls to the internal medicine resuscitation team between 1 October 2012 and 31 May 2016 were retrospectively evaluated with respect to the type of mission, mortality and characteristics.

Results

Documentation suitable for evaluation was available for 219 (44.1%) out of 497 emergency care calls, of which 93 (42.5%) were not for resuscitation but other emergencies. The hospital mortality rate of these emergencies was 24.7% (vs. 63.8% after resuscitation, p < 0.001) and the intensive care unit (ICU) admission rate was 68.5%. In 32.3% of these calls, activation was initially triggered by the keyword “resuscitation”, but the vital parameters documented on arrival of the team were within the normal range. A low Glasgow coma scale (4 vs. 14 points, p = 0.006) was of prognostic relevance.

Conclusion

Resuscitation teams are often also activated for other serious in-house emergencies. Establishing rapid response systems with predetermined activation criteria would therefore also be useful for German hospitals.

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Authors and Affiliations

  1. Campus Benjamin Franklin, Medizinische Klinik für Nephrologie, Charité – Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland

    F. Compton, A.‑S. Ramdohr,  B. Okur &  M. van der Giet

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  1. F. Compton
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  2. A.‑S. Ramdohr
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  3. B. Okur
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  4. M. van der Giet
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Correspondence to F. Compton.

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Interessenkonflikt

F. Compton, A.-S. Ramdohr, B. Okur und M. van der Giet geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Compton, F., Ramdohr, A., Okur, B. et al. Innerklinische Notfallversorgung in Deutschland. Notfall Rettungsmed 23, 587–593 (2020). https://doi.org/10.1007/s10049-019-00666-7

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