Trotz optimaler Rettungswege und hochtechnisierter klinischer Versorgung liegt die Mortalität bei Patienten mit präklinischem Herz-Kreislauf-Stillstand oft bei über 90 %. Eine optimale Akutversorgung durch standardisierte Diagnostik und Therapie kann die Überlebenschancen auf 40 % anheben. Laufende klinische Studien dienen der Schaffung von Evidenz der aktuell empfohlenen Maßnahmen, um so die Behandlungsalgorithmen der Leitlinien in der Zukunft weiter verbessern können.
Abstract
Out-of-hospital circulatory arrest represents a challenging situation in emergency medicine even until today. Despite optimal emergency care and clinical treatment pathways, we are faced with a mortality rate above 90 %. It is possible to improve the survival rate to more than 40 % under ideal clinical and preclinical conditions. Thus, more people’s life could be saved by standardized SOPs and networks in emergency medicine. About 14.000 preclinical resuscitation cases are reported in Germany per year. The prognosis out-of-hospital circulatory arrest patients is determined by best preclinical treatment including early resuscitation by bystanders. However, ethical considerations for not performing cardiopulmonary resuscitation include comorbidities, advanced age, and prognostic markers of intensive care medicine like lactate level or neuron-specific enolase. Since myocardial infarction is the underlying disease in about 3 quarters of acute circulatory arrest cases, early angiography and coronary revascularization is of upmost importance. In addition, it is essential to provide hemodynamic stabilization for prevention of multiorgan dysfunction syndrome. Neuroprotection by therapeutic hypothermia may further help to improve survival and quality of life. Mechanical circulatory support devices may be considered adjunct to pharmacological measures for hemodynamic stabilization. Due to lack of evidence, these devices are currently under evaluation and prospectively randomized trials. We expect new treatment algorithms for optimal care of these high-risk patients in the near future.
Schlüsselwörter
Herz-Kreislauf-Stillstand - Wiederbelebung - kardiogener Schock - extrakorporale kardiopulmonale Reanimation
Key words
cardiac arrest - resuscitation - cardiogenic shock - extracorporeal cardiopulmonary resuscitation
