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Welche Medikamente sind bei der Reanimation sinnvoll? Welche nicht?

Which drugs are useful during resuscitation? Which are not?

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Zusammenfassung

Einleitung

Der plötzliche Kreislaufstillstand stellt eine große therapeutische Herausforderung dar. Wie sicher und effektiv bei der Wiederbelebung vorgegangen werden soll, zeigen – soweit wie möglich – evidenzbasierte Leitlinien auf, die zuletzt 2015 aktualisiert wurden.

Methoden

Im Vordergrund stehen Basismaßnahmen zur Wiederbelebung, zu denen die Herzdruckmassage mit Beatmung (Verhältnis 30:2) und, bei einem durch Kammerflimmern bedingten Herz-Kreislauf-Stillstand, eine frühzeitige Defibrillation gehören. Die Gabe von Medikamenten ist Bestandteil der sog. erweiterten lebensrettenden Maßnahmen. Vasopressoren (Adrenalin, ggf. Vasopressin) zielen auf eine Kreislaufstabilisierung ab. Antiarrhythmika (Amiodaron, falls nicht verfügbar Lidocain) sind bei schockrefraktären ventrikulären Tachyarrhythmien indiziert. Magnesium, Natriumbikarbonat und Atropin sollen nicht mehr routinemäßig eingesetzt werden.

Schlussfolgerung

Vor dem Hintergrund eines bislang nicht eindeutig erbrachten Wirksamkeitsnachweises hat die Ambivalenz, mit der die Fachwelt der Gabe von Medikamenten bei der Wiederbelebung gegenübersteht, auch in den Leitlinien zugenommen. Verantwortlich hierfür ist eine sehr heterogene Datenlage, die im Wesentlichen auf den Ergebnissen von Beobachtungsstudien und kleinen kontrollierten Studien beruht. Von den Ergebnissen zweier derzeit laufender großer randomisierter und kontrollierter Studien, welche die Wirksamkeit von Adrenalin und von Amiodaron oder Lidocain gegenüber Placebo bei kardiopulmonaler Wiederbelebung untersuchen, darf mehr Klarheit hinsichtlich der sinnvollen Anwendung von Medikamenten bei einem Kreislaufstillstand erhofft werden.

Abstract

Introduction

Cardiopulmonary resuscitation represents a therapeutic challenge. Evidence-based guidelines, which were updated in 2015, give detailed advice on how to treat the patient.

Methods

Basic life support consists of cardiopulmonary resuscitation (30 chest compressions interrupted briefly to provide to 2 ventilations) and, if ventricular tachyarrhythmia is present, urgent cardiac defibrillation. Administration of drugs is one of the aspects of advanced life support. Vasopressors (adrenaline, vasopressin) aim to optimize coronary and cerebral perfusion. Antiarrhythmic drugs (amiodarone or lidocaine, when amiodarone is not available) are given during cardiac arrest to treat specific cardiac arrhythmias, mainly ventricular fibrillation and ventricular tachycardia.

Conclusion

However, even in current guidelines, there is growing ambivalence towards drug treatment in the setting of cardiopulmonary resuscitation. This is mainly due to a paucity of robust clinical data. Most of the studies that have addressed the efficacy and safety of drugs during resuscitation are observational studies; however, a few small randomized controlled studies also exist. Recently, two large randomized controlled studies addressing the efficacy and safety of adrenaline versus placebo and amiodarone or lidocaine versus placebo have started. Both are currently recruiting patients. The hope is that the results of these studies will help to better define the role of drugs administered during cardiopulmonary resuscitation.

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Authors and Affiliations

  1. Med. Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité – Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    Wilhelm Haverkamp

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Correspondence to Wilhelm Haverkamp.

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Haverkamp, W. Welche Medikamente sind bei der Reanimation sinnvoll? Welche nicht?. Herzschr Elektrophys 27, 15–19 (2016). https://doi.org/10.1007/s00399-016-0417-7

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