Postreanimationsbehandlung

Kernaussagen

• Die besten Behandlungsergebnisse nach kardiopulmonaler und zerebraler Reanimation lassen sich nur erzielen, wenn die Behandlung alle Glieder der Überlebenskette gleichermaßen berücksichtigt. In den ERC-Leitlinien 2005 und 2010 ist die Postreanimationsbehandlung fester Bestandteil der Empfehlungen geworden.

• Mittlerweile ist die Postreanimationskrankheit gut definiert und in vielen Details verstanden. Es ergeben sich eine Vielzahl von therapeutischen Interventionen für die Krankenhausteams, welche – früh und zielgerichtet umgesetzt – die Überlebenswahrscheinlichkeit der Patienten signifikant und relevant verbessern.

• Frühzeitig ist die Ursache des Kreislaufstillstands zu klären, um die entsprechende Kausaltherapie einzuleiten. Liegt ein akutes Koronarsyndrom oder ein Herzinfarkt dem Kollapsereignis zugrunde, so ist entweder nach initialer Wiederbelebung und Stabilisierung oder aber unter CPR eine koronare Intervention notwendig.

• Eine therapeutische Hypothermie wird präklinisch durch den Notarzt begonnen und im Krankenhaus fortgeführt.

• Des Weiteren gilt es, zielgerichtet und schnell eine hämodynamische Stabilisierung zu erreichen. Dabei werden kardiale Vorlast, peripherer Widerstand und das Herzminutenvolumen gemessen und optimiert, um insgesamt die Sauerstofftransportkapazität zu normalisieren. Mit diesem Vorgehen werden die zerebrale Erholung verbessert und kardiale Komplikationen vermindert.

• Komatöse Patienten werden intubiert und beatmet. Eine Normoventilation mit einer arteriellen oder pulsoxymetrischen O₂-Sättigung von 94–98 % ist anzustreben. Das Tidalvolumen ist auf 6 ml/kg KG und der PEEP auf 10 cm H₂O zu begrenzen. Der Blutzucker sollte engmaschig kontrolliert und mit Insulin auf Werte < 180 mg/dl gesenkt werden. Zerebrale Krämpfe und Myoklonien sind umgehend medikamentös zu behandeln. Hypotonien, Hypoxämien, Hypoglykämien und Hyperthermien sind zu vermeiden.

• Aktuelle Untersuchungen zeigen, dass dieser umfassende Therapieansatz, wenn er standardisiert umgesetzt wird, die Prognose der Patienten signifikant verbessert [54], [55], [77], [78].

• Mittlerweile ist zu fordern, dass Patienten nach CPR in ein Reanimationszentrum – entsprechend den Traumazentren – transportiert werden sollten, das PCI und Hypothermiebehandlung gemäß einem lokalen Standard 24 Stunden am Tag und 7 Tage die Woche vorhält [54], [55], [79], [80].

• Literatur

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