Prognose der Hirnfunktion nach kardiopulmonaler Reanimation und therapeutischer Hypothermie

Zusammenfassung

Die milde therapeutische Hypothermie hat als Standardbehandlung die Prognose von Patienten nach Herzstillstand und Reanimation deutlich verbessert. Eine zunehmende Anzahl von Studien aus den letzten Jahren zeigt, dass die Hypothermie-Behandlung aber auch Einfluss auf etablierte klinische und paraklinische Prognoseparameter nimmt, sodass eine Neubewertung notwendig geworden ist. Insbesondere die motorische Reaktion auf Schmerzreize und eine Serumkonzentration der neuronenspezifischen Enolase (NSE) von > 33 μg/l am Tag 3 nach Reanimation erlauben keine verlässliche Aussage mehr über ein mögliches Wiedererwachen. In der aktuellen Situation einer noch heterogenen Studienlage sollte die prognostische Einschätzung von mit Hypothermie behandelten Patienten nach Herzstillstand nur vorsichtig und in Gesamtschau mehrerer prognostischer Parameter erfolgen.

Abstract

Mild therapeutic hypothermia has become a standard treatment and has markedly improved the prognosis of patients after cardiac arrest and resuscitation. An increasing number of recent studies has shown that therapeutic hypothermia influences the prognostic value of clinical, laboratory and electrophysiological parameters in these patients. Hence, a re-evaluation of these parameters appears necessary. Specifically, motor response to painful stimuli and a serum concentration of neuron specific enolase (NSE) of >33 μg/l tested on day 3 after resuscitation do no longer allow for valid prognosis of the possibility of re-awakening. Facing the heterogeneous results from recent studies, prognosis in patients treated with hypothermia after cardiac arrest should always be based on careful interpretation of several prognostic parameters.

Schlüsselwörter

Herzstillstand - Hypothermie - Prognose - Reanimation - hypoxische Enzephalopathie

Keywords

cardiac arrest - hypothermia - prognosis - resuscitation - hypoxic encephalopathy

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