Prähospitale Thrombolyse bei Patienten mit akutem Herzinfarkt - Schon Routine oder noch die Ausnahme?

Zusammenfassung

Die frühe Anwendung einer Reperfusionstherapie führt bei Patienten mit akutem ST-Hebungsinfarkt zur Verringerung der Mortalität und Morbidität. Mit der prähospitalen Thrombolyse kann eine um 30 - 90 Minuten frühzeitigere Einleitung der thrombolytischen Therapie gegenüber der intrahospitalen Behandlung erreicht werden. Voraussetzungen zur Durchführung der prähospitalen Thrombolyse sind ein 12-Kanal-Elektrokardiogramm, zusätzlich zu einer kontinuierlichen Monitorüberwachung und die Möglichkeit zur Defibrillation. In einer Umfrage an 90 Kliniken der ALKK ergab sich, dass die Möglichkeit zur Registrierung eines 12-Kanal-EKGs im Notarztwagen in 65 (72 %) Notarztsystemen gegeben ist. Eine prähospitale Thrombolyse wird momentan bei 23 (25 %) durchgeführt und ist bei weiteren 20 (22 %) Notarztsystemen geplant. Der momentane Stand der prähospitalen Versorgung des akuten Herzinfarkts wird in einem gemeinsamen bundesweiten Register (PREMIR) der ALKK und der BAND erfasst werden.

Abstract

The early initiation of reperfusion therapy in patients with acute ST elevation myocardial infarction is associated with in improvement in clinical outcome. The prehospital initiation of thrombolysis can reduce the time interval between symptom onset and start of therapy between 30 and 90 minutes. Prerequisites for prehospital thrombolysis are a 12-lead ECG, in addition to a continuous ECG monitoring and an external defibrillator. Of 90 ambulance systems related to hospitals of the ALKK 72 % are equipped with a 12-lead ECG, prehospital thrombolysis is currently performed in 25 % and planned in another 22 %. The current status of prehospital therapy in patients with acute ST elevation myocardial infarction in Germany will be evaluated in a nationwide registry (PREMIR).

Schlüsselwörter

Akuter Herzinfarkt - Thrombolyse - prähospitale Therapie - adjuvante Therapie - Register

Key words

Acute myocardial infarction - thrombolysis - prehospital therapy - adjuvant therapy - registry

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