Skip to main content
SpringerLink
Log in

Prä- oder intrahospitaler Herz-Kreislauf-Stillstand

Häufigkeit, Ergebnisse, Perspektiven

Out-of-hospital or in-hospital cardiac arrest

Incidence, results, perspectives

  • CME Weiterbildung • Zertifizierte Fortbildung
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Die Prognose von Patienten mit prä- (pHKS) oder intrahospitalem (iHKS) Herz-Kreislauf-Stillstand durch Kammerflimmern oder pulsloser ventrikulärer Tachykardie ist schlecht, und nur 5–8% der Patienten mit pHKS bzw. 30% mit iHKS überleben ein solches Ereignis. Die Defibrillation ist das entscheidende therapeutische Verfahren und sollte beim pHKS <5 min und bei iHKS <3 min erfolgen. Pro Minute verschlechtert sich die Erfolgsrate um ca. 10%. „Frühdefibrillation“ wird als Intervention mittels automatisierter externer Defibrillatoren (AED) durch nichtärztliche 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 den 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. Zum jetzigen Zeitpunkt sollten AEDs an Plätzen installiert werden, an denen sich viele Menschen aufhalten, und auch in Kliniken. Schulungen der Mitarbeiter in Reanimationsmaßnahmen und AED-Anwendung sind unerlässlich.

Abstract

Sudden out-of-hospital cardiac arrest (oCA) is a leading cause of death in the Western world and only 5–8% of patients survive such an event. In addition, patients with an in-hospital cardiac arrest (iCA) have a poor prognosis with survival rates of <30%. Defibrillation is the most effective treatment and should be performed <5 min in patients with oCA or <3 min in patients with iCA. However, its effectiveness diminishes with each passing minute by about 10%. “Early defibrillation” is the use of automated external defibrillators (AEDs) by trained public safety personnel (“first responder”), whereas “public access” defibrillation describes AED use by people who have no specific AED training. Several studies in the USA and in Europe show that first responder defibrillation will increase the number of survivors of oCA arrest compared to paramedics. This is caused by a shorter “call to arrival time” in first responders compared to paramedics. AEDs should be installed in all public places with many people as well as in hospitals. Training of all coworkers in cardiac life support and use of the AED is essential.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

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

    Article  PubMed  CAS  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

    Google Scholar 

  3. Arntz HR, Trappe HJ (2005) Frühdefibrillation: Perspektiven und Ausblick. Herzschr Elektrophys 16: 112–117

    Article  Google Scholar 

  4. Basic Life Support Working Group of the European Resuscitation Council (1998) The 1998 european resuscitation council guidelines for adult single rescuer basic life support. Resuscitation 37: 67–80

    Article  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  6. Bergner L, Hallstrom AP, Bergner M et al. (1985) Health status of survivors of cardiac arrest and of myocardial infarction controls. Am J Public Health 75: 1321–1323

    Article  PubMed  CAS  Google Scholar 

  7. Brenner BE, Kauffman J (1993) Reluctance of internists and medical nurses to perform mouth-to-mouth resuscitation. Arch Intern Med 153: 1763–1769

    Article  PubMed  CAS  Google Scholar 

  8. Brenner BE, Van DC, Cheng D et al. (1997) Determinants of reluctance to perform CPR among residents and applicants: the impact of experience on helping behavior. Resuscitation 35: 203–211

    Article  PubMed  CAS  Google Scholar 

  9. Bunch TJ, White RD, Gersh BJ et al. (2003) Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 348: 2626–2633

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. 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

    Article  PubMed  Google Scholar 

  12. Chan PS, Krumholz HM, Nichol G et al. (2008) Delayed time to defibrillation after in-hospital cardiac arrest. N Engl J Med 358: 9–17

    Article  PubMed  CAS  Google Scholar 

  13. Cohn AC, Wilson WM, Yan B et al. (2004) Analysis of clinical outcomes following in-hospital adult cardiac arrest. Intern Med J 34: 398–402

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  15. Eisenberg MS, Hallstrom AP, Copass MK et al. (1984) Treatment of ventricular fibrillation. Emergency medical technician defibrillation and paramedic services. JAMA 251: 1723–1726

    Article  PubMed  CAS  Google Scholar 

  16. Eisenberg MS, Horwood BT, Cummins RO et al. (1990) Cardiac arrest and resuscitation: a tale of 29 cities. Ann Emerg Med 19: 179–186

    Article  PubMed  CAS  Google Scholar 

  17. European Resuscitation Council (2000) Part 4: the automated external defibrillator: key link in the chain of survival. European Resuscitation Council. Resuscitation 46: 73–91

    Article  Google Scholar 

  18. 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

  19. Hallstrom A, Cobb LA, Johnson E, Copas M (2000) Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation. N Engl J Med 342: 1546–1553

    Article  PubMed  CAS  Google Scholar 

  20. Handley AJ, Handley JA (1995) The relationship between rate of chest compression and compression relaxation ratio. Resuscitation 30: 237–241

    Article  PubMed  CAS  Google Scholar 

  21. Hazinski MF, Markenson D, Neish S et al. (2004) Response to cardiac arrest and selected life-threatening medical emergencies. The Medical Emergency Response Plan for Schools. Circulation 109: 278–291

    Article  PubMed  Google Scholar 

  22. Herlitz J, Ekstrom L, Wennerbloom B et al. (1994) Predictors of early and late survival after out-of-hospital cardiac arrest in which asystole was the first recorded arrhythmia on scene. Resuscitation 28: 27–36

    Article  PubMed  CAS  Google Scholar 

  23. Hsu JW, Madsen CD, Callaham ML (1996) Quality-of-life and formal functional testing of survivors of out-of-hospital cardiac arrest correlates poorly with traditional neurologic outcomes scales. Ann Emerg Med 28: 597–605

    Article  PubMed  CAS  Google Scholar 

  24. International Liasion Committee on resuscitation, ILCOR (2005) 2005 International consensus cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 67: 157–337

    Article  Google Scholar 

  25. Kellermann AL, Hackman BB, Somes G (1993) Predicting the outcome of unsuccessful prehospital advanced cardiac life support. JAMA 270: 1433–1436

    Article  PubMed  CAS  Google Scholar 

  26. Koster RW (2002) Automatic external defibrillator: key link in the chain of survival. J Cardiovasc Electrophysiol 13: S92–S95

    Article  PubMed  Google Scholar 

  27. Lombardi G, Gallagher EJ, Gennis P (1994) Outcome of out-of-hospital cardiac arrest in New York City: the Pre-Hospital Arrest Survival Evaluation (PHASE) Study. JAMA 271: 678–683

    Article  PubMed  CAS  Google Scholar 

  28. Maio VJ, Stiell IG, Wells GA (2001) Potential impact of public access defibrillation based upon cardiac arrest locations. Acad Emerg Med 8: 415–416

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  30. Myerburg RJ, Fenster J, Velez M et al. (2002) Impact of community-wide police car deployment of automated external defibrillators on survival from out-of-hospital cardiac arrest. Circulation 106: 1058–1064

    Article  PubMed  Google Scholar 

  31. Nadkarni VM, Larkin GL, Peberdy MA et al. (2006) First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 295: 50–57

    Article  PubMed  CAS  Google Scholar 

  32. Nichol G, Stiell IG, Hebert P et al. (1999) What ist the quality of life for survivors of cardiac arrest? A prospective study. Acad Emerg Med 6: 95–102

    Article  PubMed  CAS  Google Scholar 

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

    Google Scholar 

  34. Page RL, Joglar JA, Kowal RC et al. (2000) Use of automated external defibrillators by a U.S. airline. N Engl J Med 343: 1210–1216

    Article  PubMed  CAS  Google Scholar 

  35. Peberdy MA, Kaye W, Ornato JP et al (2003) Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the national registry of cardiopulmonary resuscitation. Resuscitation 58: 297–308

    Article  PubMed  Google Scholar 

  36. Peduzzi F, Jost, LePogann A et al. (2003) Interest of automated external defibrillations implemented in public areas receiving crowd in a urban area. Conference abstract of ERC Symposium on Early Defibrillation 28.–29.11.2003

  37. Pell JP, Sirel JM, Marsden AK et al. (2002) Potential impact of public access defibrillators on survival after out of hospital cardiopulmonary arrest: retrospective cohort study. BMJ 325: 1–5

    Article  Google Scholar 

  38. Priori SG, Bossaert LL, Chamberlain DA et al. (2004) ESC-ERC recommendations for the use of automated external defibrillators (AEDs) in Europe. Eur Heart J 25: 437–445

    Article  PubMed  Google Scholar 

  39. Sanders AB, Kern KB, Berg RA et al. (2001) Survival and neurologic outcome with four chest compression to ventilation models of cardiopulmonary resuscitation. Acad Emerg Med 8: 424–425

    Article  Google Scholar 

  40. Sandroni C, Ferro G, Santangelo S et al. (2004) In-hospital cardiac arrest: survival depends mainly on the effectiveness of the emergency response. Resuscitation 62: 291–297

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  42. Shuster M, Nolan J, Barnes TA (2002) Airway and ventilation management. In: Kern KB (ed) Cardiology clinics – emergency cardiovascular care, WB Saunders Company, pp 23–35

  43. Smith HJ, Taylor R, Mitchell A (2000) A comparison of four quality of life instruments in cardiac patients: SF-36, QLI, QLMI, and SEIQoL. Heart 84: 390–394

    Article  PubMed  CAS  Google Scholar 

  44. Stiell IG, Wells GA, DeMaio VJ (1999) Modifiable factors associated with improved cardiac arrest survival in multicenter basic life support/defibrillation system: OPAL Study Phase I results. Ontario Prehospital Advanced Life Support. Ann Emerg Med 33: 44–50

    Article  PubMed  CAS  Google Scholar 

  45. Stiell IG, Wells GA, Field B et al. (2004) Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med 351: 647–656

    Article  PubMed  CAS  Google Scholar 

  46. Sunnerhagen KS, Johansson O, Herlitz J, Grimby G (1996) Life after cardiac arrest: a retrospective study. Resuscitation 31: 135–140

    Article  PubMed  CAS  Google Scholar 

  47. Swart GL, Mateer JR, DeBehnke DJ et al. (1994) The effect of compression duration and compression on hemodynamics during mechanical high-impulse CPR. Acad Emerg Med 1: 430–437

    PubMed  CAS  Google Scholar 

  48. Swor RA, Jackson RE, Cynar M et al. (1995) Bystander CPR, ventricular fibrillation, and survival in witnessed, unmonitored out-of-hospital cardiac arrest. Ann Emerg Med 25: 780–784

    Article  PubMed  CAS  Google Scholar 

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

    Article  Google Scholar 

  50. Trappe HJ, Andresen D, Arntz HR et al. (2005) Positionspapier zur automatisierten externen Defibrillation. Z Kardiol 94: 287–295

    Article  PubMed  Google Scholar 

  51. Trappe HJ (2005) Frühdefibrillation: Wo stehen wir? Dtsch Med Wochenschr 130: 685–688

    Article  PubMed  Google Scholar 

  52. Trappe HJ (2005) Frühdefibrillation in USA, Europa und Deutschland. Voraussetzungen, Erfahrungen, Perspektiven. Herzschr Elektrophys 16: 94–102

    Article  Google Scholar 

  53. Trappe HJ, Nesslinger M, Schrage O et al. (2005) Frühdefibrillation im LAGO – die Therme – Ergebnisse und Erfahrungen. Herzschr Elektrophys 16: 103–111

    Article  Google Scholar 

  54. 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. Br J Med 327: 1312–1317

    Article  Google Scholar 

  55. Valenezuela TD, Roe DJ, Nichol G et al. (2000) Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med 343: 1206–1209

    Article  Google Scholar 

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

  57. Weaver WD, Hill D, Fahrenbruch CE et al. (1988) Use of the automatic external defibrillator in the management of out-of-hospital cardiac arrest. N Engl J Med 319: 661–666

    PubMed  CAS  Google Scholar 

  58. Wik L, Stehen PA (1996) The ventilation/compression ratio influences the effectiveness of two rescuer advanced cardiac life support on a manikin. Resuscitation 31: 113–119

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Medizinische Klinik II, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland

    H.-J. Trappe

Authors
  1. H.-J. Trappe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H.-J. Trappe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Trappe, HJ. Prä- oder intrahospitaler Herz-Kreislauf-Stillstand. Kardiologe 3, 37–46 (2009). https://doi.org/10.1007/s12181-008-0121-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12181-008-0121-x

Schlüsselwörter

Keywords

Search

Navigation