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Neue Leitlinien zur kardiopulmonalen Reanimation und ihre Implikationen für die herzchirurgische Intensivmedizin

New guidelines on cardiopulmonary resuscitation and implications for cardiac surgery critical care

  • Evidenzbasierte Medizin
  • Published:
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

International Liaison Committee on Resuscitation, American Heart Association und European Resuscitation Council veröffentlichten 2015 die aktualisierten Empfehlungen zur Wiederbelebung von Erwachsenen und Kindern, die die Leitlinien aus 2010 ersetzen. Diese beinhalten neben den Basis- (Basic Life Support) und den erweiterten Wiederbelebungsmaßnahmen (Advanced Cardiac Life Support) Empfehlungen für die Pädiatrie und die Reanimation unter speziellen Umständen, z. B. Traumapatienten, Ertrinkungsopfer oder bei Elektrolytverschiebungen. Die erweiterten Reanimationsmaßnahmen haben sich bezüglich Algorithmus und Medikamentengabe im Vergleich zu 2010 wenig geändert. Einen neuen Schwerpunkt stellt die Postreanimationsbehandlung in einem spezialisierten Zentrum mit den Möglichkeiten frühzeitiger Koronarintervention und gezielten Temperaturmanagements dar. Erstmalig wird die Implantation eines Extracorporeal-Life-Support(ECLS)-Systems bei Herz-Kreislauf-Stillstand in selektionierten Patienten empfohlen. Bereits 2010 wurden die Wiederbelebungsmaßnahmen herzchirurgischer Patienten behandelt. In der aktualisierten Version werden nun speziell Patienten nach Implantation eines „left ventricular assist device“ (LVAD) thematisiert. Der Behandlungsalgorithmus unterscheidet sich vom allgemeinen Vorgehen v. a. in der Forderung der sehr zeitnahen Resternotomie unter Reanimation nach erfolgloser Defibrillation bzw. Pacing in der frühen postoperativen Phase zur Verbesserung der Koronarperfusion unter offener Herzdruckmassage. Auch wenn bei einer chirurgischen Blutung und/oder Perikardtamponade zweifelsfrei die zeitnahe Resternotomie notwendig ist, ist dieses sehr aggressive Vorgehen aus Sicht der Autoren bei Fehlen dieser klaren Indikation kritisch unter individueller Risiko-Nutzen-Abwägung zu betrachten.

Abstract

In 2015 the International Liaison Committee on Resuscitation, the American Heart Association and the European Resuscitation Council published updated recommendations for adult and pediatric cardiopulmonary resuscitation, which replace the guidelines from 2010. In addition to basic life support (BLS) and advanced cardiac life support (ACLS) the guidelines also contain recommendations for pediatrics and resuscitation under special circumstances, e. g. trauma patients, drowning victims and electrolyte disturbances. There are only minor modifications to the previous guidelines from 2010 concerning BLS and ACLS with no relevant changes to the algorithms or medication. One new focus is post-resuscitation care in specialized centers with a greater emphasis on the need for urgent percutaneous coronary intervention and targeted temperature management. For the first time the implantation of an extracorporeal life support (ECLS) system is recommended in selected patients following cardiac arrest. Specific guidelines on resuscitation measures for cardiac surgery patients were already addressed in 2010. In the current revised version special consideration is now given to patients after implantation of a left ventricular assist device (LVAD). The treatment algorithm differs from the general approach particularly in the requirement for urgent resternotomy during resuscitation after unsuccessful defibrillation or pacing in the early postoperative period for improvement of cardiac perfusion and open chest cardiac massage. Even if there is no doubt that resternotomy is necessary in cases of surgical bleeding and pericardial tamponade, in the opinion of the authors this aggressive approach should be critically considered with respect to the individual risk-benefit assessment when these clear indications are lacking.

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Authors and Affiliations

  1. Klinik für Intensivmedizin, imland Klinik Rendsburg, Lilienstr. 22–28, 24768, Rendsburg, Deutschland

    K. Pilarczyk

  2. Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg – Bad Krozingen, Freiburg, Deutschland

    G. Trummer

  3. Abt. XVII – Klinik für Herz- und Gefäßchirurgie, Bundeswehrzentralkrankenhaus, Koblenz, Deutschland

    A. Markewitz

  4. imland Klinik Rendsburg, Lilienstr. 22–28, 24768, Rendsburg, Deutschland

    N. Haake

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  1. K. Pilarczyk
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Correspondence to K. Pilarczyk.

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K. Pilarczyk, G. Trummer, N. Haake und A. Markewitz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Pilarczyk, K., Trummer, G., Haake, N. et al. Neue Leitlinien zur kardiopulmonalen Reanimation und ihre Implikationen für die herzchirurgische Intensivmedizin. Z Herz- Thorax- Gefäßchir 30, 406–414 (2016). https://doi.org/10.1007/s00398-016-0105-2

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  • DOI: https://doi.org/10.1007/s00398-016-0105-2

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