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Notfallmedizin up2date 2014; 9(2): 131-142
DOI: 10.1055/s-0033-1357929
Reanimation
Georg Thieme Verlag KG Stuttgart · New York

Postreanimationsbehandlung

Teil 2
Matthias Fischer
,
Hans Roth
,
Jens-Christian Schewe
,
Stefan Rauch
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
10. Juni 2014 (online)

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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.

  • Die therapeutischen Bemühungen zielen auf die Minimierung eines sekundären Hirnschadens ab.

  • Eine therapeutische Hypothermie wird präklinisch durch den Notarzt begonnen und im Krankenhaus fortgeführt. Anzustreben ist eine Temperatur von 32–34 °C, die für mindestens 24 Stunden aufrechterhalten wird. Die Wiedererwärmung erfolgt je nach verwendetem Gerät aktiv oder passiv, stets aber sehr langsam.

  • Des Weiteren gilt es, zielgerichtet und schnell eine hämodynamische Stabilisierung zu erreichen. Komatöse Patienten werden intubiert und beatmet. Hyperthermien sind zu vermeiden.

  • Aktuelle Untersuchungen zeigen, dass dieser umfassende Therapieansatz, wenn er standardisiert umgesetzt wird, die Prognose der Patienten signifikant verbessert [50]–[53].

  • 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 [50], [51], [54], [55].

 

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