Zusammenfassung.
Die „Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. An International Consensus on Science” stellen die ersten wirklich internationalen Richtlinien zur kardiopulmonalen Reanimation in der Geschichte der Reanimationsmedizin dar. Experten führender internationaler Organisationen (International Liaison Committee on Resuscitation, ILCOR) erarbeiteten einen Konsensus an Empfehlungen, die zuvor einen strengen Überprüfungsprozess zu durchlaufen hatten, der nach den Prinzipien der „evidence-based medicine” arbeitete: alle vorgeschlagenen Empfehlungen bzw. Änderungen bestehender Empfehlungen mussten auf kritisch bewerteten wissenschaftlichen Daten beruhen, die in eine wertende Empfehlungsklasse zusammengefasst werden mussten. Die wichtigsten Änderungen im Vergleich zu früheren Empfehlungen des European Resuscitation Councils oder der American Heart Association werden angeführt und kommentiert.
CPR - Guidelines 2000: New International Guidelines for Cardiopulmonary Resuscitation.
The „Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. An International Consensus an Science” are the first true international CPR guidelines in the history of resuscitation medicine. Experts from major international resuscitation organizations (International Liaison Committee on Resuscitation, ILCOR) achieved a consensus of recommendations which had to pass a rigorous review procedure applying the tools of evidence- based medicine: all proposed guidelines or guideline changes had to be based on critically appraised pieces of evidence which had to be integrated into a final class of recommendations. The most important changes compared to previous recommendations from either the European Resuscitation Council or the American Heart Association are presented and commented upon.
Schlüsselwörter:
Kardiopulmonale Reanimation - CPR - Reanimationsempfehlungen - Herz-Kreislaufstillstand - Basismaßnahmen - erweiterte Maßnahmen
Key words:
Cardiopulmonary resuscitation - CPR - Guidelines for resuscitation - cardiac arrest - basic life support - advanced cardiovascular life support
Literatur
-
1 Emergency Cardiac Care Committee and Subcommittees, American Heart Association. Guidelines for cardiopulmonary resuscitation and emergency cardiac care. Recommendations of the 1992 national conference. JAMA 1992 268: 2171-2302
-
2 Guidelines for basic life support. A statement by the basic life support working party of the European Resuscitation Council 1992. Resuscitation 1992 24: 103-110
-
3 Guidelines for advanced life support. A statement by the advanced life support working party of the European Resuscitation Council, 1992. Resuscitation 1992 24: 111-121
-
4 Guidelines for the basic and advanced management of the airway and ventilation during resuscitation. A statement by the airway and ventilation management working group of the European Resuscitation Council. Resuscitation 1996 31: 187-230
-
5 Bossaert L (ed). European Resuscitation Council Guidelines for Resuscitation. Amsterdam: Elsevier 1998
-
6
The American Heart Association in Collaboration With the International Liaison Committee on Resuscitation (ILCOR). .
Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. An international consensus on science.
Circulation.
2000;
102
(Suppl I)
I-1-B5
-
7
The American Heart Association in Collaboration With the International Liaison Committee on Resuscitation (ILCOR). .
Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. An international consensus on science.
Resuscitation.
2000;
46
1-448
-
8
The American Heart Association in Collaboration With the International Liaison Committee on Resuscitation (ILCOR). .
Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. An international consensus on science. Part 1: Introduction to the international guidelines 2000 for CPR and ECC.
Circulation.
2000;
102
(Suppl I)
I-1-I-11
-
9
The American Heart Association in Collaboration With the International Liaison Committee on Resuscitation (ILCOR). .
Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. An international consensus on science. Part 3: Adult basic life support.
Circulation.
2000;
102
(Suppl I)
I-22-I-59
-
10
Dörges V, Ocker H, Hagelberg S, Wenzel V, Idris A H.
Smaller tidal volumes with room air are insufficient to ensure adequate oxygenation during basic life support.
Resuscitation.
2000;
44
37-41
-
11
Johannigman J A, Branson R D.
Oxygen enrichment of expired gas for mouth-to-mouth resuscitation.
Respir Care.
1995;
40
618-623
-
12
Weiler N, Heinrichs W, Dick W.
Assessment of pulmonary mechanics and gastric inflation pressure during mask ventilation.
Prehospital Disaster Med.
1995;
10
101-105
-
13
Wenzel V, ldris A H, Banner M J, Kubilis P S, Williams J L.
The influence of tidal volume on the distribution of gas between the lungs and stomach in the unintubated patient receiving positive pressure ventilation.
Crit Care Med.
1998;
26
364-368
-
14
Wenzel V, Idris A H, Banner M J, Kubilis P S, Band R, Williams J L, Lindner K H.
Respiratory system compliance decreases after cardiopulmonary resuscitation and stomach inflation: impact of large and small tidal volumes on calculated peak airway pressure.
Resuscitation.
1998;
38
113-118
-
15
Wenzel V, Keller C, Idris A H, Dörges V, Lindner K H, Brimacombe J R.
Effects of smaller tidal volumes during basic life support ventilation in patients with respiratory arrest: good ventilation, less risk?.
Resuscitation.
1999;
43
25-29
-
16
Eberle B, Dick W F, Schneider T, Wisser G, Doetsch S, Tzanova I.
Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse.
Resuscitation.
1996;
33
107-116
-
17
Swenson R D, Waever D, Niskanen R A, Martin J, Dahlberg S.
Hemodynamics in humans during conventional and experimental methods of cardiopulmonary resuscitation.
Circulation.
1988;
78
630-639
-
18
Kern K B, Sanders A B, Raife J, Milander M M, Otto C W, Ewy G A.
A study of chest compression rates during cardiopulmonary resuscitation in humans.
Arch Int Med.
1992;
152
145-149
-
19
Kern K B, Hilwig R W, Berg R A, Ewy G A.
Efficacy of chest compression-only BLS CPR in the presence of an occluded airway.
Resuscitation.
1998;
39
179-188
-
20
Wik L, Steen P A.
The ventilation-compression ratio influences the effectiveness of two rescuer advanced cardiac life support in a manikin.
Resuscitation.
1996;
31
113-119
-
21
Berg R A, Kern K B, Sanders A B, Otto C W, Hilwig R W, Ewy G A.
Bystander cardiopulmonary resuscitation: is ventilation necessary?.
Circulation.
1993;
88
((4 pt 1))
1907-1915
-
22
Noc M, Weil M H, Tang W, Turner T, Fukui M.
Mechanical ventilation may not essential for initial cardiopulmonary resuscitation.
Chest.
1995;
108
821-827
-
23
Hallstrom A, Cobb L, Johnson E, Copass M.
Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation.
N Engl J Med.
2000;
342
1546-1553
-
24
The American Heart Association in Collaboration With the International Liaison Committee on Resuscitation (ILCOR). .
Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. An international consensus on science. Part 4: The automated external defibrillator. Key link in the chain of survival.
Circulation.
2000;
102
(Suppl I)
I-60-I-76
-
25
Becker L, Eisenberg M, Fahrenbruch C, Cobb L.
Public locations of cardiac arrest: implications for public access defibrillation.
Circulation.
1998;
97
2106-2109
-
26
The American Heart Association in Collaboration With the International Liaison Committee on Resuscitation (ILCOR). .
Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. An international consensus on science. Part 6: Advanced cardiovascular life support.
Circulation.
2000;
102
(Suppl I)
I-86-I-171
-
27
Lindner K H, Prengel A W, Brinkmann A, Strohmenger H U, Lindner I M, Lurie K G.
Vasopressin administration in refractory cardiac arrest.
Ann Int Med.
1996;
124
1061-1064
-
28
Morris D C, Dereczyk B E, Grzybowski M.
Vasopressin can increase coronary perfusion pressure during human cardiopulmonary resuscitation.
Acad Emerg Med.
1997;
20
609-614
-
29
Lindner K H, Dirks B, Strohmenger H U.
Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation.
Lancet.
1997;
349
535-537
-
30
Brown C G, Martin D R, Pepe P E, Stueven H, Cummins R O, Gonzales E, Jastremski M. The Multicenter High-Dose Epinephrine Study Group .
A comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital.
N Engl J Med.
1992;
327
1051-1055
-
31
Stiell I G, Hebert P C, Weitzman B N, Wells G A, Raman S, Stark R M, Higginson L A, Ahuja J, Dickinson G E.
High-dose epinephrine in adult cardiac arrest.
N Engl J Med.
1992;
327
1045-1050
-
32
Callaham M, Madsen C D, Barton C W, Saunders C E, Pointer J.
A randomized clinical trial of high-dose epinephrine and norepinephrine vs. standard-dose epinephrine in prehospital cardiac arrest.
JAMA.
1992;
268
2667-2672
-
33
Lindner K H, Ahnefeld F W, Prengel A W.
Comparison of standard and high-dose adrenaline in the resuscitation of asystole and electromechanical dissociation.
Acta Anaesthesiol Scand.
1991;
35
253-256
-
34
Lipman J, Wilson W, Kobilski S, Scribante J, Lee C, Kraus P, Cooper J, Barr J, Moyes D.
High-dose adrenaline in adult in-hospital asystolic cardiopulmonary resuscitation: a double-blind randomised trial.
Anaesth Intensive Care.
1993;
21
192-196
-
35
Choux C, Gueugniaud P Y, Barbieux A, Pham E, Lae C, Dubien P Y, Petit P.
Standard doses versus repeated high doses of epinephrine in cardiac arrest outside the hospital.
Resuscitation.
1995;
25
3-9
-
36
Sherman B W, Munger M A, Foulke G E, Rutherford W F, Panacek E A.
High-dose versus standard-dose epinephrine treatment of cardiac arrest after failure of standard therapy.
Pharmacotherapy.
1997;
17
242-247
-
37
Gueugniaud P Y, Mols P, Goldstein P, Pham E, Dubien P Y, Deweerdt C, Vergnion M, Petit P, Carli P. European Epinephrine Study Group .
A comparison of repeated high doses and repeated standard doses of epinephrine for cardiac arrest outside the hospital.
N Engl J Med.
1998;
339
1595-1601
-
38
Behringer W, Kittler H, Sterz F, Domanovits H, Schoerkhuber W, Holzer M, Mullner M, Laggner A N.
Cumulative epinephrine dose during cardiopulmonary resuscitation and neurologic outcome.
Ann Int Med.
1998;
129
450-456
-
39
Kudenchuk P J, Cobb L A, Copass M K, Cummins R O, Doherty A M, Fahrenbruch C E, Hallstrom A P, Murray W A, Olsufka M, Walsh T.
Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation.
New Engl J Med.
1999;
341
871-878
Priv.-Doz. Dr. med. Hendrik W. Gervais
Klinik für Anaesthesiologie
Klinikum der Johannes Gutenberg-Universität Mainz
Langenbeckstraße 1
55131 Mainz
Email: gervais@anaesthesie.klinik.uni-mainz.de