Beatmung bei der Reanimation des Erwachsenen - Stellenwert 2008

Abstract

Modern cardiopulmonary resuscitation is based on a concept of Safar et al (1961) suggesting a combination of chest compression and ventilation. The ratio of chest compression to ventilation has been changed from 4 : 1 (1961) to 30 : 2 at the present time, because experimental and clinical studies have demonstrated that chest compression (circulation) is more important in resuscitation of cardiac arrest (ventricular fibrillation, asystole, pulsless electrical activity) than ventilation. Mouth-to-mouth breathing is associated with problems questioning its role at the beginning of resuscitation by lay rescuer. The idea of mouth-to-mouth breathing may prevent resuscitative measures at all, may be the only measure (in about 10 % of lay resuscitations), may result in gastric inflation with vomiting, takes off important time from chest compression and may decrease cardiac output and thus diminish the chance of effective defibrillation in case of ventricular fibrillation. Recently a nurse of our hospital resuscitated a bicycle driver with ventricular fibrillation by chest compression without ventilation for at least 8 - 9 minutes. After defibrillation the patient fully recovered within some hours supporting the results of animal experiments that demonstrate that ventilation may be omitted in cardiac arrest during the first 10 minutes of resuscitation. Large prospective clinical studies are required to ultimately assess the value of ventilation in resuscitation of the adult.

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