Zusammenfassung
Hintergrund
Obwohl mehrere Studien den positiven Effekt der milden therapeutischen Hypothermie (MTH) auf das Überleben wie auch auf die neurologische Erholung zeigen, findet dieses Verfahren nur zögerlich Eingang in die tägliche Routine.
Fragestellung
Wir untersuchten, welchen Effekt die Umsetzung der MTH in einem Haus der Schwerpunktversorgung auf das Krankenhausüberleben und den neurologischen Status hat.
Studiendesign und Methoden
Die Daten von 68 Patienten, die zwischen 09/2010 und 11/2011 nach Reanimation im Klinikum Dachau für 24 h eine MTH mit kontrollierter Körperkerntemperatur von 33°C erhielten, wurden mit Daten von 180 Patienten aus der Zeit vor der systemischen Kühlung (2001–2006) verglichen, die ebenfalls in einer Reanimationsstudie prospektiv erhoben worden waren. Zielparameter waren das Überleben sowie der neurologische Status bei Entlassung, bestimmt anhand der Glasgow-Pittsburgh Cerebral Performance Categories (CPC).
Ergebnisse
Die MTH verbesserte den Anteil der Patienten mit einem CPC-Score von 1 oder 2 von 70 % auf 85 %. Das Überleben steigerte sich insgesamt von 47/180 (26 %) in der Zeit von 01/2000 bis 01/2006 auf 27/68 (40 %) im Intervall von 09/2010 bis 11/2011.
Diskussion
Durch die Implementierung der MTH verbesserte sich sowohl der neurologische Status als auch das Gesamtüberleben nach kardiopulmonaler Reanimation.
Abstract
Background
The favorable effect of mild therapeutic hypothermia (MTH) on neurologic status as well as on overall survival was shown in several trials; however, MTH is not readily implemented in daily routine.
Objective
We examined the effect of the implementation of MTH on neurologic outcome and overall survival in an emergency care hospital.
Study design and methods
The data of 68 patients between 09/2010 and 11/2011 who received MTH for 24 h at 33 °C after cardiopulmonary resuscitation (CPR) were compared with prospectively collected data from 180 patients before introduction of MTH (2001–2006). Survival and neurological status at discharge were determined using the Glasgow–Pittsburgh Cerebral Performance Categories (CPC).
Results
MTH raised the percentage of patients with a CPC score of 1 or 2 from 70 % to 85 %. Furthermore, survival increased from 47/180 (26 %) between 01/2000 and 01/2006 to 27/68 (40 %) between 09/2010 and 11/2011.
Discussion
Implementation of MTH leads to improved neurological status and overall survival after CPR.
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T. Schlögl, J. Schwab, M.A. Weber, B. Witzenbichler und M.A. Russ geben an, dass kein Interessenkonflikt besteht.
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Schlögl, T., Schwab, J., Weber, M. et al. Milde therapeutische Hypothermie. Med Klin Intensivmed Notfmed 110, 597–601 (2015). https://doi.org/10.1007/s00063-015-0023-1
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DOI: https://doi.org/10.1007/s00063-015-0023-1
Schlüsselwörter
- Milde therapeutische Hypothermie
- Neurologischer Status
- Kardiopulmonale Reanimation
- Defibrillierbare Herzrhythmusstörung
- Nichtdefibrillierbare Herzrhythmusstörung