Herz-Kreislauf-Stillstand im winterlichen Hochgebirge

 

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Zusammenfassung

Die Zunahme sportlicher und touristischer Aktivitäten im Gebirge hat auch zu einer Zunahme verunfallter oder akut erkrankter Personen in diesen Gebieten geführt. Herz-Kreislauf-Stillstände im Gebirge sind durch traumatische Ereignisse, Höhenkrankheit, Kälteschädigung, Lawinenunfälle oder plötzlichen Herztod bedingt, hierbei müssen vorbestehende chronische Erkrankungen berücksichtigt werden. Insgesamt ist die Rate der tödlich verunfallten Bergsportler in den letzten Jahren in alpinen Regionen nicht angestiegen. Es wird über 3 Patienten mit Herz-Kreislauf-Stillstand im winterlichen Hochgebirge sowie deren Behandlungs- und Genesungsverlauf berichtet. Die rettungstechnischen und medizinischen Maßnahmen der Fallvorstellungen werden unter Berücksichtigung der aktuellen Literatur diskutiert.

Abstract

The increase in sporting activities and tourism in mountain areas has given rise to the number of patients with acute diseases or accidents in these areas. Cardiopulmonary arrests in the mountains are caused by trauma, high altitude illness, cold injury, avalanche burial and sudden cardiac death. In this context, the prevalence of chronic diseases of the patients has to be taken into account. Overall, the number of fatalities in mountain areas has not increased over the last years. The authors describe the cause of cardiopulmonary arrest, medical treatment, rescue operation and the recovery of three patients during winter season in high mountain area and discuss the measures based on a review of the current literature.

• Literatur

• 1 Moore LG. Altitude-aggravated illness: examples from pregnancy and prenatal life. Ann Emerg Med 1987; 16: 965-973
  CrossrefPubMedGoogle Scholar
• 2 Burtscher M, Bachmann O, Hatzl T et al. Cardiopulmonary and metabolic response in healthy elderly humans during a 1-week hiking program at high altitude. Eur J Appl Physiol 2001; 84: 379-386
  CrossrefPubMedGoogle Scholar
• 3 Schommer K, Bärtsch P. Basiswissen für die höhenmedizinische Beratung. Dtsch Arztebl Int 2011; 108: 839-848
  PubMedGoogle Scholar
• 4 Kaufmann M, Moser B, Lederer W. Changes in injury patterns and severity in a helicopter air-rescue system over a 6-year period. Wilderness Environ Med 2006; 17: 8-14
  CrossrefPubMedGoogle Scholar
• 5 Wang S, Hsu T, Kuan J et al. Medical problems requiring mountain rescues from 1985 to 2007 in Yu-Shan national park. High Alt Med Biol 2009; 10: 77-82
  CrossrefPubMedGoogle Scholar
• 6 Windsor J, Firth P, Grocott M et al. Mountain mortality: a review of death that occur during recreational activities in the mountain. Postgrad Med J 2009; 85: 316-321
  CrossrefPubMedGoogle Scholar
• 7 Schweizer Alpen-ClubSAC. Bergnotfälle Schweiz. 2012. http://www.sac-cas.ch/unterwegs/sicherheit/bergnotfallstatistik.html (11.01.2014)
  Google Scholar
• 8 Hearns S. The Scottish mountain rescue casualty study. Emerg Med J 2003; 20: 281-284
  CrossrefPubMedGoogle Scholar
• 9 Hung E, Townes D. Search and rescue in Yosemite national park: a 10 year review. Wilderness Environ Med 2007; 18: 111-116
  CrossrefPubMedGoogle Scholar
• 10 Ruedl G, Bilek H, Ebner H et al. Fatalities on Austrian ski slopes during 5-year period. Wilderness Environ Med 2011; 22: 326-328
  CrossrefPubMedGoogle Scholar
• 11 Burtscher M, Philadelphy M, Likar R. Sudden cardiac death during mountain hiking and downhill skiing. N Eng J Med 1993; 329: 1738-1739
  CrossrefPubMedGoogle Scholar
• 12 Burtscher M, Pachinger O, Schocke M et al. Risk factor profile for sudden cardiac death during mountain hiking. Int J Sports Med 2007; 28: 621-624
  Article in Thieme ConnectPubMedGoogle Scholar
• 13 Burtscher M, Ponchia A. The risk of cardiovascular events during leisure time activities at altitude. Prog Cardiovasc Dis 2010; 52: 507-511
  CrossrefPubMedGoogle Scholar
• 14 Reid W, Doyle D, Richmond H et al. Necropsy study of mountaineering accidents in Scotland. J Clin Pathol 1986; 39: 1217-1220
  CrossrefPubMedGoogle Scholar
• 15 Marsigny B, Lecoq-Jammes F, Cauchy E. Medical mountain rescue in the Mont-Blanc massif. Wilderness Environ Med 1999; 3: 152-156
  PubMedGoogle Scholar
• 16 McIntosh S, Campbell A, Dow J et al. Mountaineering fatalities on Denali, 1990 to 2008. High Alt Med Biol 2008; 9: 89-95
  CrossrefPubMedGoogle Scholar
• 17 Rodway G, McIntosh S, Dow J. Mountain research and rescue on Denali: A short history from 1980s to the present. High Alt Med Biol 2011; 12: 277-283
  CrossrefPubMedGoogle Scholar
• 18 Paal P, Milani M, Brown D et al. Termination of cardiopulmonary resuscitation in mountain rescue. High Alt Med Biol 2012; 13: 200-208
  CrossrefPubMedGoogle Scholar
• 19 Strapazzon G, Procter E, Brugger H. The quest for evidence-based medicine in mountain areas. High Alt Med Biol 2011; 12: 399-400
  CrossrefPubMedGoogle Scholar
• 20 Lischke V, Berner A, Kopp K et al. Mountain rescue services by the German Red Cross. Organisation and technical rescue principles. Notfall Rettungsmed 2012; 15: 234-240
  CrossrefPubMedGoogle Scholar
• 21 Pasquier M, Geiser V, Riedmatten M et al. Helicopter rescue operations involving winching of an emergency physician. Injury 2012; 43: 1377-1380
  CrossrefPubMedGoogle Scholar
• 22 AutoPulse. Reanimationssystem Modell 10. Bedienerhandbuch, P/N. 11440-002 Rev. 2, 2014. http://www.zollmedical.de/download-center.aspx (11.01.2014)
  Google Scholar
• 23 LUCAS. Gerät zur Thoraxkompression. Bedienungsanleitung, Deutsch, 100081-06 REV B Gültig ab COJ2066 2014. http://www.lucas-cpr.com/doc_en/LUCAS_IFU_GE2.pdf (11.01.2014)
  Google Scholar
• 24 Kämäräinen A, Virta J, Virkkunen I. Evaluation oft he effects of low temperature on performance of standard non-electric medical equipment at –21.5oC(–6.7oF) – A descriptive study on a real life challenge in the prehospital setting. Resuscitation 2012; 83: 1517-1520
  CrossrefPubMedGoogle Scholar
• 25 Narahara H, Kimura M, Suto T et al. Effects of cardiopulmonary resuscitation at high altitude on the physical conditions of untrained and unacclimatized rescuers. Wilderness Environ Med 2012; 23: 161-164
  CrossrefPubMedGoogle Scholar
• 26 Suto T, Saito S. Consideration for resuscitation at high altitude in elderly and untrained population and rescuers. Am J Emerg Med 2013; (in press, available online 12.11.2013)
  PubMedGoogle Scholar
• 27 Brown D, Brugger H, Boyd J. Accidental hypothermia. N Engl J Med 2012; 367: 1930-1938
  CrossrefPubMedGoogle Scholar
• 28 Brugger H, Durrer B, Elsensohn F et al. Resuscitation of avalanche victims: Evidence-based guidelines of the international commission for mountain emergency medicine (ICAR MEDCOM) intended for physicians and other advanced life support persons. Resuscitation 2013; 84: 539-546
  CrossrefPubMedGoogle Scholar
• 29 Paal P, Brugger H, Boyd J. Accidental Hypothermia. N Engl J Med 2013; 368: 681-682
  CrossrefPubMedGoogle Scholar
• 30 Mair P, Frimmel C, Vergeiner G et al. Emergency medical helicopter operations for avalanche accidents. Resuscitation 2013; 84: 492-495
  CrossrefPubMedGoogle Scholar
• 31 Perkins G, Brace S, Gates S. Mechanical chest-compression devices: current and future roles. Curr Opin Crit Care 2010; 16: 203-210
  CrossrefPubMedGoogle Scholar
• 32 Putzer G, Braun P, Zimmermann A et al. LUCAS compared to manual cardiopulmonary resuscitation is more effective during helicopter rescue – a prospective, randomized, cross-over manikin study. Am J Emerg Med 2013; 31: 384-389
  CrossrefPubMedGoogle Scholar
• 33 Pietsch U, Lischke V, Pietsch C et al. Mechanical chest compressions in an avalanche victim with cardiac arrest: An option for extrem mountain rescue operations. Wilderness Environ Med 2014; (in press)
  PubMedGoogle Scholar
• 34 Brodmann M, Martin D, Balthasar E et al. The Bernes hypothermia algorithm: A consensus paper on in-hospital decision-making and treatment of patients in hypothermic cardiac arrest at a alpine level 1 traum acentre. Injury 2011; 42: 539-543
  CrossrefPubMedGoogle Scholar
• 35 Bayer A, Baschnegger H. Automatisierte Thoraxkompression während Helikopterrettung mit Winde und MERS (HEC-CPR). Persönliche Information 2013
  Google Scholar
• 36 Pietsch U Persönliche Information. 2013
  PubMed
• 37 Faulhaber M, Flatz M, Gatterer H et al. Prevalence of cardiovascular diseases among alpine skiers and hikers in the Austrian alps. High Alt Med Biol 2007; 8: 245-252
  CrossrefPubMedGoogle Scholar
• 38 Berghold F, Schaffert W. Physiologie und Medizin der grossen und extremen Höhe. 2012. www.franzberghold.at/fachinformation (11.01.2014)
  Google Scholar
• 39 Albert C, Mittleman M, Chae C et al. Triggering of sudden death from cardiac causes by vigorous exertion. N Eng J Med 2000; 343: 1355-1361
  CrossrefPubMedGoogle Scholar
• 40 Alexander J. Cardiac arrhythmia at high altitude. Tex Heart Inst J 1999; 26: 258-263
  PubMedGoogle Scholar
• 41 Barcella L, Agazzi G, Malgrati D et al. First aid and public access defibrillation in mountain huts: The Mountain Hut Initiative of the Bergamo section of the Club Alpino Italiano. Wilderness Environ Med 2010; 21: 379-381
  CrossrefPubMedGoogle Scholar
• 42 Burtscher M. Risk of cardiovascular events during mountain activities. In: Roach R, Wagner P, Hackett P, eds. Hypoxia and the circulation. New York: Springer; 2007: 1-11
  CrossrefGoogle Scholar
• 43 Lienhart H, Breitfeld L, Voelckel W. Frühdefibrillation im Gletscherskigebiet: Übertrieben oder Überleben? 3 Fallberichte und eine Standortbestimmung. Anästhesiol Intensivmed Notfallmed Schmerzther 2005; 40: 150-155
  Article in Thieme ConnectPubMedGoogle Scholar
• 44 Smith B. Bringing ALS to the mountain. EMSWORLD.com; November 2011. http://emsworld.epubxp.com/i/45328 (11.01.2014)
  Google Scholar
• 45 Usatch B, Cone D. Automated external defibrillator training and skill retentic at the ski patrol. Prehosp Emerg Care 2001; 6: 325-329
  PubMedGoogle Scholar
• 46 Elsensohn F, Agazzi G, Syme D et al. The use of automated external defibrillators and public access defibrillators in the mountains: Official guidelines of the international commission for mountain emergency medicine ICAR-MEDCOM. Wilderness Environ Med 2006; 17: 64-66
  CrossrefPubMedGoogle Scholar
• 47 Elsensohn F, Soteras I, Reisten O et al. Equipment of medical backpacks in mountain rescue. High Alt Med Biol 2011; 12: 343-347
  CrossrefPubMedGoogle Scholar
• 48 Bouillon B, Walther T, Kraemer M et al. Trauma und Herz-Kreislaufstillstand. Anesthesist 1994; 43: 786-790
  CrossrefPubMedGoogle Scholar
• 49 Hubert-Wagner S, Lefering R, Qvick M et al. Outcome in 757 severely injured patients with traumatic cardiorespiratory arrest. Resuscitation 2007; 75: 276-285
  CrossrefPubMedGoogle Scholar
• 50 Gräsner J, Wnent S, Seewald S et al. Cardiopulmonary resuscitation traumatic cardiac arrest – there are survivors. An analysis of two national emergency registries. Crit Care 2011; 15: R276
  CrossrefPubMedGoogle Scholar
• 51 Bouillon B, Wafaisade A, Helm P et al. Reanimation nach Trauma. Notfall Rettungsmed 2013; 16: 527-531
  CrossrefPubMedGoogle Scholar
• 52 Gilbert M, Busund R, Skagseth A et al. Resuscitation from accidental hypothermia of 13.7 degree C with circulatory arrest. Lancet 2000; 355: 375-376
  CrossrefPubMedGoogle Scholar
• 53 Oberhammer R, Beikirchner W, Hörmann C et al. Full recovery of an avalanche victim with profound hypothermia and prolonged cardiac arrest treatet by extracorporeal re-warming. Resuscitation 2008; 76: 474-480
  CrossrefPubMedGoogle Scholar
• 54 Hill J, Hardekopf S, Chen J et al. Successful resuscitation after multiple injuries in the wilderness. J Emer Med 2013; 44: 440-443
  CrossrefPubMedGoogle Scholar
• 55 Ruedl G, Sommersacher R, Woldrich T et al. Risikofaktoren von Kopfverletzungen auf österreichischen Skipisten. Deutsche Zeit Sportmed 2010; 61: 97-102
  PubMedGoogle Scholar
• 56 Ackery A, Hagel B, Provvidenza C et al. An international review of head and spinal cord injuries in alpine skiing and snowboarding. Injury Prevention 2007; 13: 368-375
  CrossrefPubMedGoogle Scholar
• 57 Cusimano M, Kwok J. The effectiveness of helmet wear in skiers and snowboarders: A systemic review. Br J Sport Med 2010; 44: 781-786
  CrossrefPubMedGoogle Scholar
• 58 Franz T, Hasler R, Benneker L et al. Severe spinal injuries in alpin skiing and snowboarding: A 6 year review of a tertiary trauma center for the Bernese alps ski resorts, Switzerland. Br J Sports Med 2008; 42: 55-58
  PubMedGoogle Scholar
• 59 Furlan J, Fehlings M. Cardiovascular complications after acute spinal cord injury: Pathophysiology, diagnosis and management. Neurosurg Focus 2008; 25: 1-15
  PubMedGoogle Scholar
• 60 Techel F, Zweifel B. Recreational avalanche accidents in Switzerland: Trends and patterns with an emphasis on burial, rescue methods and avalanche danger. International Snow Science Workshop Grenoble – Chamonix Mont-Blanc – 2013. http://www.slf.ch/praevention/lawinenunfaelle/Publikationen/Techel_Zweifel_Unfaelle_ISSW_2013_Paper.pdf (11.01.2014)
  Google Scholar
• 61 Lawinenstatistik Winter 2013/2014. In: Österreichisches Kuratorium für alpine Sicherheit (eds): Analyse: Berg Winter 2013/2014. Innsbruck: Alpina Druck; 2013: 68-72
  Google Scholar
• 62 Haegeli P, Falk M, Brugger H et al. Comparison of avalanche survival patterns in Canada and Switzerland. CMAJ 2011; 183, 789-795
  PubMedGoogle Scholar
• 63 Brugger H, Paal P, Boyd J. Prehospital resuscitation of the buried avalanche victim. High Alt med Biol 2011; 12: 199-205
  CrossrefPubMedGoogle Scholar
• 64 Brugger H, Durrer B. On-site treatment of avalanche victims ICAR-MEDCOM-recommendation. High Alt Med Biol 2002; 3: 421-425
  CrossrefPubMedGoogle Scholar
• 65 Althaus U, Aeberhard P, Schüpbach P et al. Management of profound accidental hypothermia with cardiorespiratory arrest. Ann Surg 1982; 195: 492-495
  CrossrefPubMedGoogle Scholar
• 66 Walpoth B, Walpoth-Aslan B, Mattle H et al. Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming. N Engl J Med 1997; 337: 1500-1505
  CrossrefPubMedGoogle Scholar
• 67 Boue Y, Lavolaine J, Bouzat P et al. Neurologic recovery from profound accidental hypothermia after 5 hours of cardiopulmonary resuscitation. Crit Care Med 2013; 42: 1-4
  PubMedGoogle Scholar