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Pulmonalembolie als Ursache des Herzstillstandes: Diagnosestellung und Management

Pulmonary embolism as a cause of cardiac arrest: Diagnosis and management

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Intensivmedizin und Notfallmedizin

Abstract

Obstruction of the pulmonary arteries by fulminant massive pulmonary embolism (PE) may lead to cardiac arrest. PE is responsible for 6–11%, the second most frequent cause, of out of hospital cardiac arrests. Signs of congested cervical veins and electrocardiographic evidence of pulseless electrical activity should raise clinical suspicion of massive PE. Echocardiographic evidence of an enlarged right ventricle should further strengthen that diagnosis. In this situation and under ongoing cardiopulmonary resuscitation, thrombolysis with a bolus of rt-PA up to a dosage of 100 mg is promising with respect of restoring spontaneous circulation, 24 hour survival, and even hospital dismission rate. Bleeding rate is significantly increased by thrombolytic treatment. This effect however is outweighed by its beneficial effect on survival. After successful reanimation post resuscitation care has to be performed according to established guidelines. Recurrence of PE has to be prevented by long-term anticoagulation and implantation of a caval filter, if clinically mandatory.

Zusammenfassung

Durch Obstruktion der Lungenstrombahn kann im Rahmen einer fulminanten Pulmonalembolie (PE) ein Herzstillstand auftreten. Die PE ist mit 6–11% die zweithäufigste Ursache aller präklinischen Herzstillstände. Die Zeichen der oberen Einflussstauung und der Nachweis einer pulslosen elektrischen Aktivität im ersten EKG sollten den Verdacht auf das Vorliegen einer PE lenken. Durch den Nachweis eines vergrößerten rechten Ventrikels in der Echokardiographie kann dieser Verdacht erhärtet werden. In dieser Situation ist unter laufenden Reanmiationsmaßnahmen auf Grund der Datenlage die Bolusverabreichung von rt-PA bis zu einer Gesamtdosis von 100 mg Erfolg versprechend in Hinblick auf Wiederherstellung der Kreislauffunktion, 24-Stunden-Überlebensrate und Spitalentlassungsrate. Das unter Thrombolyse signifikant erhöhte Blutungsrisiko wird durch diese günstigen Effekte übertroffen. Die nach erfolgreicher Reanimation durchzuführende Behandlung stützt sich auf die dafür geltenden allgemeinen Richtlinien und der Verhinderung von Rezidiven durch Dauerantikoagulation und eventuelle Implantation eines Cavaschirms.

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  1. Univ. Klinik f. Notfallmedizin, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18–20, 1090, Wien, Austria

    Karin Janata, Istepan Kürkciyan &  Anton N. Laggner

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  1. Karin Janata
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  2. Istepan Kürkciyan
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  3. Anton N. Laggner
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Correspondence to Anton N. Laggner.

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Janata, K., Kürkciyan, I. & Laggner, A.N. Pulmonalembolie als Ursache des Herzstillstandes: Diagnosestellung und Management. Intensivmed 45, 277–281 (2008). https://doi.org/10.1007/s00390-008-0889-8

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  • DOI: https://doi.org/10.1007/s00390-008-0889-8

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