Reanimation einer Schwangeren

 

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Zusammenfassung

Wir berichten über eine 26-jährige Schwangere in der 37. Gestationswoche, die leblos in der Wohnung vorgefunden wurde. Initial lag Kammerflimmern vor, weshalb eine Schockabgabe durch den AED erfolgte. Die endotracheale Intubation gestaltete sich schwierig, weshalb eine alternative Atemwegssicherung mit einem Larynxtubus notwendig wurde. Da auch nach mehrmaligen Adrenalingaben und weiteren Schockabgaben kein Spontankreislauf zu etablieren war, entschloss sich der Notarzt zur Fibrinolyse, da eine Lungenarterienembolie als reversible Ursache für den Kreislaufstillstand in Betracht gezogen werden musste. Unter Fortsetzung der Reanimationsmaßnahmen wurde die Patientin mit der Feuerwehr aus dem mehretagigen Wohnhaus in den RTW und weiter in den Kreißsaal transportiert. Auch die Entbindung des Kindes durch die notfallmäßige Sectio caesarea konnten weder das Leben der Mutter noch das des Kindes retten.

Die Reanimation einer Schwangeren unterscheidet sich hinsichtlich des Algorithmus, der Thoraxkompressionen, der Defibrillation und der Medikamentengabe nicht von nichtschwangeren Patienten. Bei Schwangeren ab der 20. Gestationswoche kann es durch den Uterus zu einer aortokavalen Kompression kommen, was zu einer deutlichen Verringerung der Vorlast und des Herzzeitvolumens führt. Eine Linksseitenlage oder eine manuelle Verlagerung des Uterus nach links führt zwar zu einer Dekompression der Gefäße, kann die Effektivität der Thoraxkompressionen jedoch verschlechtern. Sollten die initialen Reanimationsmaßnahmen erfolglos bleiben, kann die Entbindung des Fetus per Notfallsektio die Überlebenschance von Mutter und Kind verbessern. Daher sollte jede reanimationspflichtige, schwangere Patientin unter kontinuierlicher Fortführung der Reanimationsmaßnahmen schnellstmöglich in eine geeignete Klinik transportiert werden.

Abstract

We report the case of a 26-year-old pregnant woman in the week 37 of gestation, who was found lifeless at home by her husband. The initial heart rhythm indicated ventricular fibrillation and defibrillation through the AED was performed. A laryngeal tube turned out to be necessary for airway management as endotracheal intubation was difficult. Even after repeated doses of epinephrine and additional defibrillation, spontaneous circulation could not be established. Hence the emergency physician decided to execute intravenous fibrinolysis, as pulmonary embolism had to be considered as a potential cause of cardiac arrest. Simultaneously, the hospital was informed in order to prepare an emergency cesarean section. While continuing the cardiopulmonary resuscitation, the patient was transported to the delivery room. However, unfortunately the delivery of the child by cesarean section could not save the mother’s and the child’s life.

The resuscitation of a pregnant woman does not differ from non-pregnant patients in terms of the algorithms, the chest compression, defibrillation and drug administration. From the week 20 of gestation on, aortocaval compression through the uterus may occur. This may lead to significant reduction in preload and cardiac output. Although a left-lateral position or manual displacement of the uterus to the left may result in decompression of the vessels, concomitantly, effectivity of chest compressions may be reduced. If the initial resuscitative efforts are unsuccessful, the delivery of the fetus by an emergency cesarean section can improve the chance of survival of mother and child. Therefore, each pregnant woman requiring cardiopulmonary resuscitation should be transported – under continuous prosecution of resuscitation actions – as quickly as possible into an appropriate clinic.

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