Therapeutische Hypothermie in der Intensivmedizin

Kernaussagen

Die schlechte Prognose von Patienten nach Herz-Kreislauf-Stillstand wird neben dem unmittelbaren hypoxischen Neuronenuntergang vor allem durch Schäden in der Reperfusionsphase verursacht. Die therapeutisch induzierte milde Hypothermie (32-34 °C für 12-24 Stunden) kann die Entstehung vieler Vorgänge, die zu diesen Sekundärschädigungen führen, verhindern oder zumindest reduzieren. Die Prognose nach Herzstillstand kann durch die milde Hypothermie deutlich verbessert werden.

Ob nicht-invasive oder invasive Kühlmethoden angewendet werden, ist für die Effektivität der Hypothermie unerheblich. Je schneller die Zieltemperatur erreicht werden kann, desto größer ist wahrscheinlich der neuroprotektive Effekt.

Die therapeutische milde Hypothermie kann jedoch ebenso wie die unbeabsichtigte perioperative Hypothermie unerwünschte Nebenwirkungen haben. Zu den wichtigsten potenziellen Problemen zählen die Beeinträchtigung der Gerinnung, Wundheilungsstörungen und Wundinfektionen sowie kardiale Komplikationen. Dennoch wird die Anwendung der therapeutischen milden Hypothermie bei komatösen Patienten nach Herz-Kreislauf-Stillstand in den Leitlinien des European Resuscitation Councils (ERC) ausdrücklich empfohlen.

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