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Notfallmedizin up2date 2023; 18(04): 375-394
DOI: 10.1055/a-2040-9978
Allgemeine und organisatorische Aspekte

Postreanimationsbehandlung – vom Erkennen des Spontankreislaufs zur Intensivmedizin

Camilla Metelmann
,
Stephan Katzenschlager
,
Kevin Roedl
,
Stephan Seewald
,
Jan Wnent
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Die Postreanimationsbehandlung beginnt unmittelbar nach dem Wiedereintritt des Spontankreislaufs (Return of Spontaneous Circulation; ROSC) und endet erst mit der Entlassung der Betroffenen aus der Klinik und der anschließenden Rehabilitationsbehandlung. Insofern haben schon die Maßnahmen, die im Rettungsdienst direkt nach dem ROSC ergriffen werden, einen deutlichen Einfluss auf die Langzeitprognose.
Kernaussagen

  • Bei Patient*innen mit Kreislaufstillstand, die durch die Reanimation einen Spontankreislauf (ROSC) erlangen, schließt sich unmittelbar nach Erreichen des ROSC die Postreanimationsphase an.

  • Unmittelbar nach dem ROSC sind die Patient*innen häufig noch hämodynamisch und respiratorisch instabil, sodass eine hohe Gefahr eines erneuten Kreislaufstillstands (Re-Arrest) besteht.

  • Um die Gefahr eines Re-Arrests zu minimieren und die neurologische Langzeitprognose zu verbessern, sollten in dieser vulnerablen Phase eine kontinuierliche Überwachung stattfinden und eine strukturierte Postreanimationsbehandlung begonnen werden.

  • Die Postreanimationsbehandlung erfolgt nach dem ABCDE-Schema und hat zum Ziel, eine Normoxie, Normokapnie, Normotension und Fiebervermeidung zu erreichen.

  • Eine endotracheale Intubation durch erfahrene Teams scheint der Verwendung von supraglottischen Atemwegshilfen überlegen zu sein.

  • Es sollte systematisch die Ursache des Kreislaufstillstands gesucht und mögliche Verletzungen identifiziert werden.

  • Zur weiteren Behandlung sollten die Patient*innen in das nächstgelegene geeignete Krankenhaus (am besten Cardiac Arrest Center) transportiert werden.

  • Während des Transports sollte weiterhin eine Reanimationsbereitschaft bestehen.

  • Durch die prähospital durchgeführten Maßnahmen in der Postreanimationsphase kann das Team einen entscheidenden Einfluss auf die Langzeitprognose der Patient*innen nehmen.

Schlüsselwörter

ROSC - Reanimation - ABCDE-Schema - ERC-Leitlinien - Kreislaufstillstand - Return of spontaneous Circulation


Publication History

Article published online:
05 December 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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