Postreanimationsbehandlung

Kernaussagen

• Die besten Behandlungsergebnisse nach kardiopulmonaler und zerebraler Reanimation lassen sich nur erzielen, wenn die Behandlung alle Glieder der Überlebenskette gleichermaßen berücksichtigt. In den ERC-Leitlinien 2005 und 2010 ist die Postreanimationsbehandlung fester Bestandteil der Empfehlungen geworden.

• Mittlerweile ist die Postreanimationskrankheit gut definiert und in vielen Details verstanden. Es ergeben sich eine Vielzahl von therapeutischen Interventionen für die Krankenhausteams, welche – früh und zielgerichtet umgesetzt – die Überlebenswahrscheinlichkeit der Patienten signifikant und relevant verbessern.

• Die therapeutischen Bemühungen zielen auf die Minimierung eines sekundären Hirnschadens ab.

• Eine therapeutische Hypothermie wird präklinisch durch den Notarzt begonnen und im Krankenhaus fortgeführt. Anzustreben ist eine Temperatur von 32–34 °C, die für mindestens 24 Stunden aufrechterhalten wird. Die Wiedererwärmung erfolgt je nach verwendetem Gerät aktiv oder passiv, stets aber sehr langsam.

• Des Weiteren gilt es, zielgerichtet und schnell eine hämodynamische Stabilisierung zu erreichen. Komatöse Patienten werden intubiert und beatmet. Hyperthermien sind zu vermeiden.

• Aktuelle Untersuchungen zeigen, dass dieser umfassende Therapieansatz, wenn er standardisiert umgesetzt wird, die Prognose der Patienten signifikant verbessert [50]–[53].

• Mittlerweile ist zu fordern, dass Patienten nach CPR in ein Reanimationszentrum – entsprechend den Traumazentren – transportiert werden sollten, das PCI und Hypothermiebehandlung gemäß einem lokalen Standard 24 Stunden am Tag und 7 Tage die Woche vorhält [50], [51], [54], [55].

• Literatur

• Ghuysen A, Collas D, Stipulante S. et al. Dispatcher-assisted telephone cardiopulmonary resuscitation using a French-language compression-only protocol in volunteers with or without prior life support training: A randomized trial. Resuscitation 2011; 82: 57-63
• Dami F, Fuchs V, Praz L. et al. Introducing systematic dispatcher-assisted cardiopulmonary resuscitation (telephone-CPR) in a non-Advanced Medical Priority Dispatch System (AMPDS): implementation process and costs. Resuscitation 2010; 81: 848-852
• Berdowski J, Beekhuis F, Zwinderman AH. et al. Importance of the first link: description and recognition of an out-of-hospital cardiac arrest in an emergency call. Circulation 2009; 119: 2096-2102
• Gräsner J, Wnent J, Gräsner I. et al. Einfluss der Basisreanimationsmaßnahmen durch Laien auf das Überleben nach plötzlichem Herztod. Notfall Rettungsmed 2012; 15: 593-599
• Neukamm J, Graesner JT, Schewe JC. et al. The impact of response time reliability on CPR incidence and resuscitation success – a benchmark study from the German Resuscitation Registry. Crit Care 2011; 15: R282-R282
• Eisenberg MS, Horwood BT, Cummins RO. et al. Cardiac arrest and resuscitation: a tale of 29 cities. Ann Emerg Med 1990; 19: 179-186
• Koster RW, Baubin MA, Bossaert LL. et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation 2010; 81: 1277-1292
• Xu Y, Liachenko S, Tang P. Dependence of early cerebral reperfusion and long-term outcome on resuscitation efficiency after cardiac arrest in rats. Stroke 2002; 33: 837-843
• Lukas RP, Grasner JT, Seewald S. et al. Chest compression quality management and return of spontaneous circulation: a matched-pair registry study. Resuscitation 2012; 83: 1212-1218
• Frascone RJ, Wayne MA, Swor RA. et al. Treatment of non-traumatic out-of-hospital cardiac arrest with active compression decompression cardiopulmonary resuscitation plus an impedance threshold device. Resuscitation 2013; 84: 1214-1222
• Aufderheide TP, Frascone RJ, Wayne MA. et al. Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial. Lancet 2011; 377: 301-311
• Breil M, Krep H, Heister U. et al. Randomised study of hypertonic saline infusion during resuscitation from out-of-hospital cardiac arrest. Resuscitation 2012; 83: 347-352
• Bender R, Breil M, Heister U. et al. Hypertonic saline during CPR: Feasibility and safety of a new protocol of fluid management during resuscitation. Resuscitation 2007; 72: 74-81
• Jarnum H, Knutsson L, Rundgren M. et al. Diffusion and perfusion MRI of the brain in comatose patients treated with mild hypothermia after cardiac arrest: A prospective observational study. Resuscitation 2009; 80: 425-430
• 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
• Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002; 346: 549-556
• Holzer M. Targeted temperature management for comatose survivors of cardiac arrest. N Engl J Med 2010; 363: 1256-1264
• Testori C, Sterz F, Behringer W. et al. Mild therapeutic hypothermia is associated with favourable outcome in patients after cardiac arrest with non-shockable rhythms. Resuscitation 2011; 82: 1162-1167
• Testori C, Sterz F, Holzer M. et al. The beneficial effect of mild therapeutic hypothermia depends on the time of complete circulatory standstill in patients with cardiac arrest. Resuscitation 2012; 83: 596-601
• Van den Berghe G, Wouters P, Weekers F. et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001; 345: 1359-1367
• Deakin CD, Nolan JP, Soar J. et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation 2010; 81: 1305-1352
• Zeiner A, Holzer M, Sterz F. et al. Mild resuscitative hypothermia to improve neurological outcome after cardiac arrest. A clinical feasibility trial. Hypothermia After Cardiac Arrest (HACA) Study Group. Stroke 2000; 31: 86-94
• 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
• Coimbra C, Drake M, Boris-Moller F. et al. Long-lasting neuroprotective effect of postischemic hypothermia and treatment with an anti-inflammatory/antipyretic drug: evidence for chronic encephalopathic processes following ischemia. Stroke 1996; 27: 1578-1585
• Arrich J, Holzer M, Havel C. et al. Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database Syst Rev 2012; 9: CD004128-CD004128
• Böttiger BW, Schneider A, Popp E. Number needed to treat = six: therapeutic hypothermia following cardiac arrest – an effective and cheap approach to save lives. Crit Care 2007; 11: 162-162
• Nielsen N, Wetterslev J, Cronberg T. et al. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. New Engl J Med 2013; 369: 2197-2206
• Knapik P, Rychlik W, Duda D. et al. Relationship between blood, nasopharyngeal and urinary bladder temperature during intravascular cooling for therapeutic hypothermia after cardiac arrest. Resuscitation 2012; 83: 208-212
• Weihs W, Schratter A, Sterz F. et al. The importance of surface area for the cooling efficacy of mild therapeutic hypothermia. Resuscitation 2011; 82: 74-78
• Franz A, Michalski T, Miller E. et al. Präklinische therapeutische Hypothermie nach Reanimation. Intensivmedizin 2011; 48: 527-530
• Uray T, Haugk M, Sterz F. et al. Surface cooling for rapid induction of mild hypothermia after cardiac arrest: design determines efficacy. Acad Emerg Med 2010; 17: 360-367
• Heard KJ, Peberdy MA, Sayre MR. et al. A randomized controlled trial comparing the Arctic Sun to standard cooling for induction of hypothermia after cardiac arrest. Resuscitation 2010; 81: 9-14
• Haugk M, Sterz F, Grassberger M. et al. Feasibility and efficacy of a new non-invasive surface cooling device in post-resuscitation intensive care medicine. Resuscitation 2007; 75: 76-81
• Kamarainen A, Virkkunen I, Tenhunen J. et al. Prehospital therapeutic hypothermia for comatose survivors of cardiac arrest: a randomized controlled trial. Acta Anaesthesiol Scand 2009; 53: 900-907
• Bernard SA, Smith K, Cameron P. et al. Induction of therapeutic hypothermia by paramedics after resuscitation from out-of-hospital ventricular fibrillation cardiac arrest: a randomized controlled trial. Circulation 2010; 122: 737-742
• Bernard S, Buist M, Monteiro O. et al. Induced hypothermia using large volume, ice-cold intravenous fluid in comatose survivors of out-of-hospital cardiac arrest: a preliminary report. Resuscitation 2003; 56: 9-13
• Kamarainen A, Virkkunen I, Tenhunen J. et al. Induction of therapeutic hypothermia during prehospital CPR using ice-cold intravenous fluid. Resuscitation 2008; 79: 205-211
• Holzer M, Mullner M, Sterz F. et al. Efficacy and safety of endovascular cooling after cardiac arrest: cohort study and Bayesian approach. Stroke 2006; 37: 1792-1797
• Gillies MA, Pratt R, Whiteley C. et al. Therapeutic hypothermia after cardiac arrest: a retrospective comparison of surface and endovascular cooling techniques. Resuscitation 2010; 81: 1117-1122
• Ferreira I, Schutte M, Oosterloo E. et al. Therapeutic mild hypothermia improves outcome after out-of-hospital cardiac arrest. Neth Heart J 2009; 17: 378-384
• Al-Senani FM, Graffagnino C, Grotta JC. et al. A prospective, multicenter pilot study to evaluate the feasibility and safety of using the CoolGard System and Icy catheter following cardiac arrest. Resuscitation 2004; 62: 143-150
• Castren M, Nordberg P, Svensson L. et al. Intra-arrest transnasal evaporative cooling: a randomized, prehospital, multicenter study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness). Circulation 2010; 122: 729-736
• Busch HJ, Eichwede F, Fodisch M. et al. Safety and feasibility of nasopharyngeal evaporative cooling in the emergency department setting in survivors of cardiac arrest. Resuscitation 2010; 81: 943-949
• Sandroni C, Cavallaro F, Callaway CW. et al. Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: A systematic review and meta-analysis. Part 2: Patients treated with therapeutic hypothermia. Resuscitation 2013; 84: 1324-1338
• Sandroni C, Cavallaro F, Callaway CW. et al. Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: A systematic review and meta-analysis. Part 1: Patients not treated with therapeutic hypothermia. Resuscitation 2013; 84: 1310-1323
• Gold B, Puertas L, Davis SP. et al. Awakening after cardiac arrest and post resuscitation hypothermia: Are we pulling the plug too early?. Resuscitation 2014; 85: 211-214
• Huntgeburth M, Adler C, Rosenkranz S. et al. Changes in Neuron-Specific Enolase are More Suitable Than Its Absolute Serum Levels for the Prediction of Neurologic Outcome in Hypothermia-Treated Patients with Out-of-Hospital Cardiac Arrest. Neurocrit Care 2013; DOI: 10.1007/s12028-013-9848-8
• Oddo M. Prognostication after cardiac arrest: Time to change our approach. Resuscitation 2012; 83: 149-150
• Oddo M, Rossetti AO. Predicting neurological outcome after cardiac arrest. Curr Opinion Crit Care 2011; 17: 254-259
• Grasner JT, Meybohm P, Caliebe A. et al. Postresuscitation care with mild therapeutic hypothermia and coronary intervention after out-of-hospital cardiopulmonary resuscitation: a prospective registry analysis. Crit Care 2011; 15: R61-R61
• Tomte O, Andersen GO, Jacobsen D. et al. Strong and weak aspects of an established post-resuscitation treatment protocol-A five-year observational study. Resuscitation 2011; 82: 1186-1193
• Sunde K, Pytte M, Jacobsen D. et al. Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation 2007; 73: 29-39
• Werling M, Thoren AB, Axelsson C. et al. Treatment and outcome in post-resuscitation care after out-of-hospital cardiac arrest when a modern therapeutic approach was introduced. Resuscitation 2007; 73: 40-45
• Nolan JP, Soar J. Post resuscitation care-time for a care bundle?. Resuscitation 2008; 76: 161-162
• Wnent J, Seewald S, Heringlake M. et al. Choice of hospital after out-of-hospital cardiac arrest – a decision with far-reaching consequences: a study in a large German city. Crit Care 2012; 16: R164-R164