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Notfall + Rettungsmedizin

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01.05.2010 | Leitthema

Therapiestrategien des Post-Reanimationssyndromes

verfasst von: R. Tulder, N. Vorauer, Univ. Prof. Dr. W. Schreiber

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 3/2010

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Zusammenfassung

Der Herz-Kreislauf-Stillstand ist nach wie vor mit einem schlechten Outcome vergesellschaftet. Wird ein Herz-Kreislauf-Stillstand überlebt, kommt es zum sog. Post-Reanimationssyndrom, das durch initiale myokardiale Dysfunktion, einen Schaden des Gehirns und unspezifische inflammatorische Prozesse charakterisiert ist.

Die Therapiestrategien fokussieren beim primär erfolgreich Wiederbelebten neben der Aufrechterhaltung der Vitalfunktionen einerseits auf die kausale Behandlung evidenter Ursachen des Herz-Kreislauf-Stillstandes und andererseits auf die Beeinflussung des Post-Reanimationssyndroms. Ein kontinuierliches kompetentes Monitoring der hämodynamischen (Herzfrequenz und -rhythmus, Blutdruck, zentraler Venendruck, Diurese) und respiratorischen (periphere Sauerstoffsättigung, alveolärer Sauerstoff- bzw. Kohlensäurepartialdruck), sowie metabolischen (pH-Wert, Laktat, Blutzucker) Parameter soll Tendenzen rasch erkennen und entsprechend gegensteuern lassen.

Für die kausale Therapie des zerebralen Post-Reanimationssyndroms hat im letzten Jahrzehnt die milde therapeutische Hypothermie die Prognose der Patienten hinsichtlich Überleben und der neurologischen Qualität des Überlebens signifikant positiv beeinflusst. Sie sollte so früh wie möglich mit einer Zieltemperatur von 33°C (±1°C) für die Dauer von 24–48 h etabliert werden.

Für die schwierige Prognoseabschätzung ist der klinisch-neurologische Status in Zusammenschau mit sensomotorisch-evozierten Potenzialen, neuronenspezifischer Enolase (NSE) und S100 am besten geeignet.

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Titel: Therapiestrategien des Post-Reanimationssyndromes
verfasst von: R. Tulder
N. Vorauer
Univ. Prof. Dr. W. Schreiber
Publikationsdatum: 01.05.2010
Verlag: Springer-Verlag
Erschienen in: Notfall + Rettungsmedizin / Ausgabe 3/2010
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI: https://doi.org/10.1007/s10049-009-1278-y

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Zusammenfassung

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