Kardiogener Schock – pädiatrische Besonderheiten

Kernaussagen

• Ein kardiogener Schock ist bei Kindern im Vergleich zu Erwachsenen wesentlich seltener.

• Die Ursachen für einen Schock bei Kindern sind vielfältig und unterscheiden sich deutlich von denen bei Erwachsenen.

• Bei Kindern mit kardiogenem Schock unterscheidet sich die weitere Behandlung ganz erheblich von derjenigen bei septischen oder hypovolämischen Patienten. Eine aggressive Flüssigkeitstherapie kann den Patienten mit kardiogenem Schock sogar gefährden.

• Es ist besonders wichtig, die wenigen Kinder mit rein kardiogenem Schock zügig zu identifizieren und spezifisch zu behandeln.

• Die Therapie eines kardiogenen Schocks sollte möglichst immer eine ursachenspezifische, kurative Therapie sein.

• Die medikamentöse Therapie des kardiogenen Schocks sollte als Zielparameter nicht den Blutdruck, sondern vor allem das Herzzeitvolumen haben. Die Kombination von Inotropika und Nachlastsenkung ist effektiver als eine alleinige Anhebung des Blutdrucks.

• Sind alle Methoden der konservativen Therapie einer akuten Herzinsuffizienz ausgeschöpft, steht als letzte Möglichkeit die mechanische Kreislaufunterstützung zur Verfügung.

• Literatur

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