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Echokardiographie als Wegweiser in der Peri-Reanimation

Ein Advanced-Life-Support-konformes Konzept

Echocardiography as a guide in peri-resuscitation

An Advanced Life Support-compliant concept

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Der Kardiologe Aims and scope

Zusammenfassung

Bei der Anwendung von Echokardiographie in der Intensiv- und Notfallmedizin zeichnet sich ein Paradigmenwechsel ab: Im Gegensatz zur zeitintensiven geplanten systematischen Untersuchung durch einen Spezialisten in einem Echokardiographielabor soll ein erstbetreuender Arzt bei Notfallpatienten eine fokussierte Ultraschalluntersuchung selbstständig durchführen. Einige Differenzialdiagnosen können bei kardiozirkulatorischen oder pulmonalen Notfällen mithilfe einer klinischen Untersuchung und Standarddiagnostik nicht gestellt werden. Bei Hypotension oder Schock unklarer Genese und während der kardiopulmonalen Reanimation können wichtige behandelbare Ursachen wie die pulslose elektrische Aktivität mit Wandbewegungen, Perikarderguss und -tamponade, akute Rechtsherzbelastung als Hinweis für die Lungenarterienembolie, Hypovolämie oder Pneumothorax mit Ultraschall erkannt und damit besser behandelt werden. Ärzte sind gemäß den aktuellen Reanimationsleitlinien verpflichtet, solche behandelbaren Ursachen frühestmöglich zu erkennen oder auszuschließen. Für diese Notfallsituationen wurde das Konzept der „Focused Echocardiographic Evaluation in Life Support“ (FEEL) entwickelt. Es handelt sich dabei um eine Advanced-Life-Support-konforme Anwendung zur Aufklärung behandelbarer Ursachen in Notfällen und dessen Trainingsmethode. Ärzte mit Basiswissen in fokussierter Echokardiographie könnten dadurch ausgewählte Diagnosen in der Peri-Reanimation schneller erhalten sowie Therapiekonsequenzen ableiten.

Abstract

The application of echocardiography in intensive care and emergency medicine leads to a paradigm shift: Instead of a time-consuming systematic investigation by a specialist in an echocardiography laboratory, the first attending physician of emergency patients can perform an independent focused ultrasound investigation. Some differential diagnoses in cardio-circulatory or pulmonary emergency cases cannot be made with clinical investigation and standard diagnostics alone. In cases of undifferentiated hypotension or shock and during cardiopulmonary resuscitation (CPR) important treatable conditions like pulseless electrical activity, pericardial effusion and tamponade, acute pulmonary embolism, hypovolemia or pneumothorax can be detected by ultrasound and lead to better treatment. Physicians are obligated by current guidelines to identify and correct treatable conditions as early as possible. For these emergency situations the concept of “focused echocardiographic evaluation in life support (FEEL)” has been developed. This is essentially an Advanced Life Support-compliant application. Physicians with basic knowledge in focused echocardiography could thus more rapidly obtain diagnoses in peri-resuscitation care and derive therapy consequences.

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Abbreviations

ALS:

Advanced Life Support

BLS:

Basic Life Support

CPR:

kardiopulmonale Reanimation

FEEL:

focused echocardiographic evaluation in life support

HDM:

Herzdruckmassage

LA:

linkes Atrium

LV:

linker Ventrikel

PEA:

pulslose elektrische Aktivität

RA:

rechtes Atrium

ROSC:

return of spontaneous circulation

RV:

rechter Ventrikel

SIRS:

systemic inflammatory response syndrome

TTE:

transthorakale Echokardiographie

VCI:

Vena cava inferior

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Authors and Affiliations

  1. Herz- und Thoraxzentrum, Abteilung Kardiologie, Kerckhoff-Klinik, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland

    M. Campo dell‘ Orto, C. Hamm & A. Rolf

  2. Medizinische Klinik, Sana Krankenhaus Benrath, Düsseldorf, Deutschland

    T. Dill

  3. Medizinische Klinik 3, Kardiologie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt, Deutschland

    F.H. Seeger

  4. Abteilung für Unfall-, Hand und Wiederherstellungschirurgie, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt, Deutschland

    F. Walcher

  5. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum und Medizinische Fakultät des Saarlandes, Homburg/Saar, Deutschland

    R. Breitkreutz

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  1. M. Campo dell‘ Orto
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  2. C. Hamm
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  4. T. Dill
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  5. F.H. Seeger
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  6. F. Walcher
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  7. R. Breitkreutz
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Correspondence to M. Campo dell‘ Orto.

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Campo dell‘ Orto, M., Hamm, C., Rolf, A. et al. Echokardiographie als Wegweiser in der Peri-Reanimation. Kardiologe 4, 407–424 (2010). https://doi.org/10.1007/s12181-010-0289-8

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  • DOI: https://doi.org/10.1007/s12181-010-0289-8

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