Zusammenfassung
□ Hintergrund
Aktive Kompression, kombiniert mit aktiver Dekompression (ACD-CPR) mit Hilfe einer Druck-Saugglocke (Cardio Pump®, Ambu Int.), führt zu einer verbesserten Organdurchblutung während der kardiopulmonalen Reanimation im Vergleich zur Standardreanimationstechnik. Die Ergebnisse präklinischer Studien differieren in den verschiedenen Zentren und sind von den logistischen Gegebenheiten des jeweiligen Rettungssystems abhängig: Die Einführung der ACD-CPR führte in einigen Zentren zu einer signifikanten Erhöhung der Überlebensrate, während sie in anderen, Zentren das Reanimationsresultat nicht beeinflußte.
□ Material und Methoden
Ziel unserer prospektiven, randomisierten Untersuchung war es, den Einfluß der aktiven Kompressions-Dekompressions-Reanimation (ACD-CPR) auf die Überlebensrate und die neurologische Langzeitprognose von Patienten mit außerklinisch aufgetretenem Kreislaufstillstand in einem notarztgestützten Rettungssystem zu untersuchen.
□ Ergebnisse
Die beiden Untersuchungsgruppen waren vergleichbar bezüglich Alter, Geschlecht, Vorerkrankungen, primärer Rhythmusdiagnose, Anteil an Ersthelferreanimation und der Zeitintervalle bis zum Beginn der einzelnen Reanimationsmaßnahmen. Im Gesamtkollektiv, gab es keine signifikanten Unterschiede in der Überlebensrate und der neurologischen Langzeitprognose zwischen den Gruppen. Die Nebenwirkungsrate durch das jeweilige Reanimationsverfahren war nicht unterschiedlich.
□ Schlußfolgerung
In unserem notarztgestützten Rettungssystem mit relativ langen Einsatzzeiten führte die aktive Kompressions-Dekompressions-Reanimation weder zu eine rsignifikanten Erhöhung der Überlebensrate noch zu einer verbesserten neurologischen Langzeitprognose bei Patienten mit präklinischem akutem Kreislaufstillstand. Unsere Resultate stehen im Einklang mit den Ergebnisse aus Zentren mit vergleichbaren Einsatzzeiten.
Summary
□ Background
Improved cardiopulmonary circulation with active compression-decompression resuscitation (ACD-CPR) has been demonstrated in studies using different animal models and a small number of humans in cardiac arrest (CA). However, prehospital studies have shown both positive and no extra benefit of ACD-CPR on survival rates and neurologic outcome.
□ Material and Methods
The aim of our prospective study was to compare standard manual CPR (S-CPR) to ACD-CPR as the initial technique of resuscitating patients with out-of-hospital CA with respect to survival rates and neurological outcome in our two-tiered EMS system with physicians in the field.
□ Results
Patients with out-of-hospital CA treated by emergency medical services (EMS) personnel were randomly assigned to 1 of 2 groups (ACD-CPR versus S-CPR). The treatment groups were similar with respect to age, sex, time interval from collapse to CPR, defibrillation and first epinephrine medication. There was no difference between the ACD group and the standard CPR group in terms of survival rates and neurologic outcome. No differences occured concerning complications of CPR.
□ Conclusion
In our two-tiered EMS system with physician-staffed ambulances ACD-CPR neither improved nor impaired the survival rates and the neurological prognosis in patients with out-of-hospital cardiac arrest. Our results are in accordance with other studies carried out in EMS systems, with first tier call-response intervals between 4 and 6 min.
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Herrn Professor Dr. Hans-Peter Schuster zum sechzigsten Geburtstag
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Mauer, D., Schneider, T., Dick, W. et al. Aktive Kompressions-Dekompressions-Reanimation (ACD-CPR). Med. Klin. 92, 381–388 (1997). https://doi.org/10.1007/BF03042567
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DOI: https://doi.org/10.1007/BF03042567
Schlüsselwörter
- Alternative Reanimationsmethoden
- Akute Kompressions-Dekompressionsreanimation
- Qualitätskontrolle
- Überlebensrate
- Reanimationskomplikationen