Der beatmete Patient nach kardiopulmonaler Reanimation - Milde Hypothermiebehandlung verbessert neurologisches Outcome

Leider ist die völlige neurologische Erholung nach einem Herz-Kreislauf-Stillstand noch immer ein seltenes Ereignis. Ein standardisiertes Vorgehen - beruhend auf der Behandlung der zugrunde liegenden Ursachen, der frühen Revaskularisierung (wenn indiziert), einem optimierten Blutdruckmanagement zur Aufrechterhaltung der Nierenfunktion und einer optimalen Glukosekontrolle - ist das grundlegende Prinzip der Intensivtherapie nach einem Herzstillstand. Darüber hinaus kann durch die Anwendung der milden therapeutischen Hypothermie bei bewusstlosen Patienten nach einem Herz-Kreislauf-Stillstand das neurologische Ergebnis erheblich verbessert werden. Dabei sollte die Köperkerntemperatur der Patienten über zwölf bis 24 Stunden auf 32-34°C abgesenkt werden. Nur sechs Patienten müssen auf diese Weise behandelt werden, um bei einem zusätzlichen Patienten die neurologischen Ergebnisse zu verbessern.

In industrial countries, the incidence of out-of-hospital sudden cardiac arrest accounts for 36 to 128 per 100000 inhabitants per year. Unfortunately, full cerebral recovery after cardiac arrest is still a rare event. A standardized treatment protocol including early decision for active therapy, treatment of the underlying cause of cardiac arrest, early revascularisation if indicated, blood pressure management to maintain adequate urine output and optimal glucose control are the basic principles of intensive care after cardiac arrest. Furthermore, mild therapeutic hypothermia therapy should be considered for unconscious patients successfully resuscitated from cardiac arrest. They should be cooled to 32-34 °C over twelve to 24 hours. The introduction of therapeutic hypothermia after cardiac arrest in everyday intensive care practice could save thousands of lives worldwide, as only six patients have to be treated to get one additional patient with favourable neurological recovery.

Key words

body temperature - heart arrest - brain ischemia - induced hypothermia - resuscitation

Literatur

• 1 Becker LB, Smith DW, Rhodes KV.. Incidence of cardiac arrest: a neglected factor in evaluating survival rates.  Ann Emerg Med. 1993;  22 86-91
• 2 Bernard SA, Gray TW, Buist MD. et al. . Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.  N Engl J Med. 2002;  346 557-563
• 3 Buunk G, van der Hoeven JG, Meinders AE.. Cerebrovascular reactivity in comatose patients resuscitated from a cardiac arrest.  Stroke. 1997;  28 1569-1573
• 4 European Resuscitation Council. . European Resuscitation Council guidelines for resuscitation 2005.  Resuscitation. 2005;  67
• 5 Hachimi-Idrissi S, Corne L, Ebinger G. et al. . Mild hypothermia induced by a helmet device: a clinical feasibility study.  Resuscitation. 2001;  51 275-281
• 6 Holzer M, Bernard SA, Hachimi-Idrissi S. et al. . Hypothermia for neuroprotection after cardiac arrest: systematic review and individual patient data meta-analysis.  Crit Care Med. 2005;  33 414-418
• 7 Langhelle A, Tyvold SS, Lexow K. et al. . In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway.  Resuscitation. 2003;  56 247-263
• 8 Laurent I, Monchi M, Chiche JD. et al. . Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest.  J Am Coll Cardiol. 2002;  40 2110-2116
• 9 Losert H, Sterz F, Roine RO. et al. . Strict normoglycaemic blood glucose levels in the therapeutic management of patients within 12h after cardiac arrest might not be necessary.  Resuscitation. 2008;  76 214-220
• 10 Müllner M, Sterz F, Binder M. et al. . Arterial blood pressure after human cardiac arrest and neurological recovery.  Stroke. 1996;  27 59-62
• 11 Negovsky VA.. Postresuscitation disease.  Crit Care Med. 1988;  16 942-946
• 12 Richling N, Herkner H, Holzer M. et al. . Thrombolytic therapy vs primary percutaneous intervention after ventricular fibrillation cardiac arrest due to acute ST-segment elevation myocardial infarction and its effect on outcome.  Am J Emerg Med. 2007;  25 545-550
• 13 Spaulding CM, Joly LM, Rosenberg A. et al. . Immediate coronary angiography in survivors of out-of-hospital cardiac arrest.  N Engl J Med. 1997;  336 1629-1633
• 14 The Hypothermia After Cardiac Arrest (HACA) study group. . Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.  N Engl J Med. 2002;  346 549-556

1 Hypothermia After Cardiac Arrest

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