Leitliniennovelle 2015 – Was gibt es Neues bei der Reanimation von Erwachsenen?

Kernaussagen

Entscheidend für die Prognose nach Herzstillstand ist die zeitige, unterbrechungsfreie und gut ausgeführte Basisreanimation. Dies schlägt sich auch in den Leitlinien nieder. Während in den Leitlinien und Ausbildungsbemühungen vorangegangener Jahre technische und medikamentöse Maßnahmen im Fokus standen, sind es heute die Basismaßnahmen. Prognosebestimmend für den Patienten sind einfache aber wichtige Aktionen wie

• das frühe Erkennen eines Kreislaufstillstands,

• die telefonische Anleitung zur Wiederbelebung durch den Leitstellendisponenten,

• die suffiziente Basisreanimation durch den Laienhelfer und

• die frühe Defibrillation.

Die Basisreanimation wird in der bisherigen Form beibehalten:

• 30 Thoraxkompressionen : 2 Beatmungen

• Beatmung mit 500–600 ml, die eine sichtbare Thoraxexkursion hervorruft.

• Kompression mit einer Frequenz von 100–120/min und einer Drucktiefe von 5–6 cm, die so wenig wie möglich unterbrochen werden sollte.

• Defibrillation, sofern erforderlich, sobald wie möglich, dann alle 5 Zyklen

Diese überaus wichtigen Basismaßnahmen werden durch erweiterte Maßnahmen ergänzt, wobei sich das Vorgehen seit 2010 nicht geändert hat. Der Stellenwert der Postreanimationsbehandlung nimmt zu, daher ist diesem Thema und dem eigenständigen Krankheitsbild des Postreanimationssyndroms ein eigenes Kapitel in den Leitlinien gewidmet. Zudem gehen die Leitlinien auf die CPR in besonderen Situationen mit eigenen Algorithmen ein, wie z. B. für Anaphylaxie, Lawinenunfall oder traumatisch bedingter Kreislaufstillstand.

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