Notfall + Rettungsmedizin

, Volume 8, Issue 5, pp 306–314 | Cite as

Reanimationsregister der Arbeitsgemeinschaft Leitender kardiologischer Krankenhausärzte

Originalien

Zusammenfassung

Die Quote der überlebenden Patienten nach kardiopulmonaler Reanimation liegt in den meisten Untersuchungen unter 20%. Um diese Quote zu verbessern, ist zunächst eine Statuserhebung nötig, die die verbesserungsbedürftigen Punkte erfasst. Entsprechend wurde ein Register aufgebaut, das an Kliniken der Arbeitsgemeinschaft leitender kardiologischer Krankenhausärzte (ALKK) Patienten mit kardiopulmonaler Reanimation sowohl innerhalb als auch außerhalb des Krankenhauses erfassen sollte. Bei diesen Patienten wurden die diagnostischen und therapeutischen Maßnahmen auf kardiologisch-internistischen Intensivstationen erfasst und insbesondere hinsichtlich der Prognose ausgewertet. Zwischen Januar 1999 und März 2000 wurden insgesamt 1144 Patienten aus 32 Kliniken der ALKK in das Reanimationsregister eingeschlossen. Nur 21% der reanimierten Patienten haben das primär versorgende Krankenhaus lebend verlassen. Neben dem Alter und weiteren Co-Morbiditäten bestimmten in erster Linie die Zeit vom Kreislaufstillstand bis zum Beginn der Reanimationsmaßnahmen und das primäre EKG die Prognose der Patienten. Um die Reanimationserfolge zukünftig zu verbessern, sind Strategien zum schnellstmöglichen Beginn der Reanimation wie die Schulung von Angehörigen oder die Verbreitung der Frühdefibrillation daher von großer Bedeutung.

Schlüsselwörter

Reanimationsregister Herz-Kreislauf-Stillstand Plötzlicher Herztod Kardiopulmonale Reanimation Behandlungsqualität 

Resuscitation registry of the working group of hospital chief cardiologists

Abstract

The quota of patients surviving cardiopulmonary resuscitation is below 20% in most studies. To increase this quota, it is first necessary to assess the current status to determine which points are in need of improvement. Consequently, a registry was established with the aim of collecting data from the clinics of the working group of hospital chief cardiologists (WGCC) on patients who had undergone cardiopulmonary resuscitation both in-hospital and off-site. The diagnostic and therapeutic measures undertaken for these patients on cardiological/internal medicine wards were recorded and evaluated, particularly with respect to prognosis. A total of 1144 patients treated between January 1999 and March 2000 at 32 clinics of the WGCC were included in the resuscitation registry. Only 21% of the resuscitated patients left the primary care hospital alive. Besides age and the presence of concomitant comorbidities, the time from circulatory arrest until resuscitative procedures were initiated and the primary EKG were the chief determinants of the patient’s prognosis. To improve the success rate of resuscitations in the future, strategies for commencing resuscitation as quickly as possible as well as training for family members or widespread provision of early defibrillation are thus of the utmost importance.

Keywords

Resuscitation registry Cardiovascular arrest Sudden cardiac death Cardiopulmonary resuscitation Treatment quality 

Literatur

  1. 1.
    Callans DJ (2004) Out-of-hospital cardiac arrest — The solution is shocking. N Engl J Med 351: 632–634CrossRefPubMedGoogle Scholar
  2. 2.
    Public Access Defibrillation Trial Investigators (2004) Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med 351: 637–646PubMedGoogle Scholar
  3. 3.
    Stiell IG, Wells GA, Field B et al. for the Ontario Prehospital Advanced Life Support Study Group (2004) Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med 351: 647–656CrossRefPubMedGoogle Scholar
  4. 4.
    Carlsson J, Götz J, Miketic S et al. (1998) Kurz- und Langzeitüberleben nach cardiopulmonaler Reanimation. Intensivmedizin 35: 34–41CrossRefGoogle Scholar
  5. 5.
    Cantor MD, Braddock CH, Derse AR et al. (2003) Do-not-resuscitate orders and medical futility. Arch Intern Med 163: 2689–2694CrossRefPubMedGoogle Scholar
  6. 6.
    Jackson EA, Yarzebski JL, Goldberg RJ et al. (2004) Do-not-resuscitate orders in patients hospitalized with acute myocardial infarction. Arch Intern Med 164: 776–783CrossRefPubMedGoogle Scholar
  7. 7.
    Stiell IG, Nichol G, Wells G et al. (2003) Health-related quality of life is better for cardiac arrest survivors who received citizen cardiopulmonary resuscitation. Circulation 108: 1939–1944CrossRefPubMedGoogle Scholar
  8. 8.
    Mashiko K, Otsuka T, Shimazaki S et al. (2002) An outcome study of out-of-hospital cardiac arrest using the Utstein template — a Japanese experience. Resuscitation 55: 241–246CrossRefPubMedGoogle Scholar
  9. 9.
    Herlitz J, Bang A, Gunnarsson J et al. (2003) Factors associated with survival discharge among patients hospitalised alive after out of hospital cardiac arrest: change in outcome over 20 years in the community of Göteborg, Sweden. Heart 89: 25–30CrossRefPubMedGoogle Scholar
  10. 10.
    Finn JC, Jacobs IG, Holman CDJ, Oxer HF (2001) Outcomes of out-of-hospital cardiac arrest in Perth, Western Australia, 1996–1999. Resuscitation 51: 247–255CrossRefPubMedGoogle Scholar
  11. 11.
    Holmberg M, Holmberg S, Herlitz J (2000) Incidence, duration and survival of ventricular fibrillation in out-of-hospital cardiac arrest patients in Sweden. Resuscitation 44: 7–17CrossRefPubMedGoogle Scholar
  12. 12.
    Rea TD, Crouthamel M, Eisenberg MS et al. (2003) Temporal patterns in long-term survival after resuscitation from out-of-hospital cardiac arrest. Circulation 108: 1196–1201CrossRefPubMedGoogle Scholar
  13. 13.
    Sanders AB (1999) Do we need a clinical decision rule for the discontinuation of cardiac arrest resuscitations? Arch Intern Med 159: 119–121CrossRefPubMedGoogle Scholar
  14. 14.
    Van Walraven C, Forster AJ, Stiell IG (1999) Derivation of a clinical decision rule for the discontinuation of in-hospital cardiac arrest resuscitation. Arch Intern Med 159: 129–134CrossRefPubMedGoogle Scholar
  15. 15.
    Van Walraven C, Forster AJ, Parish DC, Dane FC, Chandra KMD, Whaley C, Stiell I (2001) Validation of a clinical decision aid to discontinue in-hospital cardiac arrest resuscitations. JAMA 285: 1602–1606CrossRefPubMedGoogle Scholar
  16. 16.
    Hillmann K, Parr M, Flabouris A, Bishop G, Stewart A (2001) Redefining in-hospital resuscitation: concept of the medical emergency team. Resuscitation 48: 105–110CrossRefPubMedGoogle Scholar
  17. 17.
    De Vos R, De Haes HCJM, Koster RW, De Haan RJ (1999) Quality of survival after cardiopulmonary resuscitation. Arch Intern Med 159: 249–254CrossRefPubMedGoogle Scholar
  18. 18.
    Cobb LA, Fahrenbruch CE, Walsh TR et al. (1999) Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation. JAMA 281: 1182–1188CrossRefPubMedGoogle Scholar
  19. 19.
    Stiell IG, Wells GA, Field BJ et al. (1999) Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program. OPALS Study Phase II. JAMA 281: 1175–1181CrossRefPubMedGoogle Scholar
  20. 20.
    Leah V, Coats TJ (1999) In-hospital resuscitation — what should we teaching? Resuscitation 41: 179–183CrossRefPubMedGoogle Scholar
  21. 21.
    Henderson SO, Ballesteros D (2001) Evaluation of a hospital-wide resuscitation team: does it increase survival for in hospital cardiopulmonary arrest? Resuscitation 48: 111–116CrossRefPubMedGoogle Scholar
  22. 22.
    Peberdy MA, Kaye W, Ornato JP et al. (2003) Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resucitation 58: 297–308CrossRefGoogle Scholar
  23. 23.
    Zafari AM, Zarter SK, Heggen V et al. (2004) A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy. J Am Coll Cardiol 44: 846–852CrossRefPubMedGoogle Scholar
  24. 24.
    Arntz HR (2004) Frühdefibrillation in Deutschland. Entwicklungen und Erfahrungen im arztbegleiteten Rettungsdienst. Notfall Rettungsmed 7: 12–17CrossRefGoogle Scholar
  25. 25.
    Basic Life Support and Automated External Defibrillation Working Group, Executive Committee of the European Resuscitation Council (2001) European Resuscitation Council guidelines 2000 for adult basic life support. Resuscitation 48: 199–205CrossRefPubMedGoogle Scholar
  26. 26.
    Zylka-Menhorn V, Forum Bundesärztekammer (2004) Kenntnisse in der Reanimation weisen Mängel auf. Dtsch Ärztebl 101: B77–B78Google Scholar
  27. 27.
    Sefrin P (2004) Reanimation eine Herausforderung für jeden Arzt. Dtsch Ärztebl 101: B966–B968Google Scholar
  28. 28.
    Pfeifer R, Börner A, Figulla HR (2004) Prognose nach Herzkreislaufstillstand. Intensivmedizin 41: 171–180CrossRefGoogle Scholar
  29. 29.
    Madl C, Hasibeder W, Lechleitner P et al. (2002) Empfehlungen zur Prognosebeurteilung bei cerebraler Hypoxie nach kardiopulmonaler Reanimation. Österreichische interdisziplinäre Konsensuskonferenz. Intensivmedizin 39: 117–124CrossRefGoogle Scholar
  30. 30.
    Ruppert M, Hoffmann G, Urban B, Lackner CK (2004) Public Access Defibrillation — Internationale Projekte. Notfall Rettungsmed 7: 18–21CrossRefGoogle Scholar
  31. 31.
    Saklayen M, Liss H, Markert R (1995) In-hospital cardiopulmonary resuscitation. Survival in 1 hospital and literature review. Medicine (Baltimore) 74: 163–174Google Scholar
  32. 32.
    Zoch TW, Desbiens NA, DeStefano F, Stueland DT, Layde PM (2000) Short- and long-term survival after cardiopulmonary resuscitation. Arch Intern Med 160: 1969–1973CrossRefPubMedGoogle Scholar
  33. 33.
    Böttiger BW, Grabner C, Bauer H, Bode C, Weber T, Motsch J Martin E (1999) Long term outcome after out-of-hospital cardiac arrest with physician staffed emergency medical services: the Utstein style applied to a midsized urban/suburban area. Heart 82: 674–679PubMedGoogle Scholar
  34. 34.
    de Vreede-Swagemakers JJ, Gorgels AP, Dubois-Arbouw WI et al. (1998) Circumstances and causes of out-of-hospital cardiac arrest in sudden death survivors. Heart 79: 356–361PubMedGoogle Scholar
  35. 35.
    Plaisance P, Lurie KG, Vicaut E et al. (1999) A comparison of standard cardiopulmonary resuscitation and active compression-decompression resuscitation for out-of-hospital cardiac arrest. N Engl J Med 341: 569–575CrossRefPubMedGoogle Scholar
  36. 36.
    de Vos R, Hanneke CJM, de Haes MS, Koster RW, de Haan RJ (1999) Quality of survival after cardiopulmonary resuscitation. Arch Intern Med 159: 249–254CrossRefPubMedGoogle Scholar
  37. 37.
    Cummins RO, Sanders A, Mancini E, Hazinski MF (1997). In-hospital resuscitation. A statement for healthcare professionals from the American Heart Association Emergency Cardia Care Committee and the Advanced Cardiac Life Support, BasicLife Support, Pediatric Resuscitation, and Program Administration Subcommittees. Circulation 95: 2211–2212PubMedGoogle Scholar
  38. 38.
    Kaye W, Mancine KK, Richards N et al. (1995) Strengthening the in-hospital chain of survival with rapid defribrillation by first responders using automated external defibrillators: training and retention issues. Ann Emerg Med 25: 163–168PubMedGoogle Scholar
  39. 39.
    Schultz SC, Cullinane DC, Pasquale MD, Magnant C, Evans SRT (1996) Predicting in-hospital mortality during cardiopulmonary resuscitation. Resuscitation 33: 13–17CrossRefPubMedGoogle Scholar
  40. 40.
    Trappe HJ, Andresen D, Arntz HR, Becker HJ, Werdan K (2005) Positionspapier zur „Automatisierten Externen Defibrillation“ der Deutschen Gesellschaft für Kardiologie in Zusammenarbeit mit der Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin. Z Kardiol 94: 287–295CrossRefPubMedGoogle Scholar
  41. 41.
    Trappe HJ (2005) Frühdefibrillation: Wo stehen wir? Dtsch Med Wochenschr 130: 685–688CrossRefPubMedGoogle Scholar
  42. 42.
    Gräsner JT, Fischer M und die AG Reanimationsregister der DGAI (2005) Das DGAI-Reanimationsregister. Strukturierte Reanimationsdatenerfassung — Datensatz „Erstversorgung“. Anästhesiol Intensivmed 46: 42–45Google Scholar
  43. 43.
    Gräsner JT, Fischer M, Altemeyer KH et al. (2005) Nationales Reanimationsregister. Strukturierte Datenerfassung mit dem DGAI-Reanimationsdatensatz „Erstversorgung“. Notfall Rettungsmed 8: 112–115CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2005

Authors and Affiliations

  1. 1.Klinikum Lippe GmbHDetmold
  2. 2.Klinik für KardiologieKlinikum Lippe GmbHDetmold

Personalised recommendations