Update Postreanimationserkrankung – neue Evidenz und Rolle der Inflammation

Kernaussagen

• Die Postreanimationserkrankung ist ein Krankheitsbild, das nach primär überlebtem Herz-Kreislauf-Stillstand regelmäßig auftritt und unter anderem zu einer hypoxischen Hirnschädigung und/oder einer myokardialen Dysfunktion unterschiedlichen Schweregrades führen oder diese verstärken kann.

• Pathophysiologisch liegen der Postreanimationserkrankung in erster Linie inflammatorische Vorgänge im Sinne eines SIRS zugrunde. Die Aktivierung des Endothels und des Gerinnungssystems nach Ischämie und Reperfusion spielen eine wichtige Rolle.

• In der Initialphase nach Wiedereintritt des Spontankreislaufs ist ein rasches Erkennen und konsequentes Behandeln der Ursachen der Reanimationspflichtigkeit notwendig. Die therapeutischen Prinzipien in der Postreanimationsphase sollten sich auf die Prophylaxe und Minimierung von Folgeschäden richten.

• Man sollte Behandlungsprotokolle einführen mit einer Vorgabe von Zielwerten für hämodynamische Kenngrößen, Oxygenierung, Beatmung, Temperatur und Blutzucker sowie mit geeigneten Lagerungsmaßnamen und Vorgaben zur Behandlung von Myoklonien.

• Empfohlen wird auch eine milde therapeutische Hypothermie mit einer Zieltemperatur von 32 – 34 °C. Entscheidend ist hierbei, die hypotherme Körpertemperatur rasch zu erreichen und strikt aufrechtzuerhalten.

• Patienten nach erfolgreicher Reanimation sollte man zur Verbesserung des Überlebens und des neurologischen Outcomes rasch in ein in der Postreanimationsbehandlung erfahrenes Zentrum verlegen.

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