Abstract
Since the 1960s, cardiopulmonary resuscitation is the recommended treatment for patients with cardiac arrest. Although this has been taught to both medical staff and the general population, the prognosis of patients with cardiac arrest remains grim. Surprisingly, the results with respect to survival and functional capacity of in-hospital cardiac arrest with subsequent cardiopulmonary resuscitation do not differ from out-of-hospital data.
In the past, a number of risk factors for sudden cardiac death have been identified. Moreover, besides chest compression prompt defibrillation has been emphasized as the intervention of choice to save a patient’s life.
Recently utilizing the data from two large registries the impact of a) delay in defibrillation (i.e., defibrillation within 2 min vs longer than 2 min after cardiac arrest, and b) time of the day and day of the week (with respect to the weekend) on survival figures and functional patient outcome have been evaluated.
Both analyses have convincingly demonstrated the dependency of clinical outcomes (i.e. survival) from in-hospital structures and processes. Obviously structure elements such as on site availability of specifically trained physicians and nurses is of utmost importance for patient survival.
Zusammenfassung
Obschon Maßnahmen zur kardiopulmonalen Reanimation bei Patienten mit Herz-Kreislaufstillstand seit den 1960er Jahren propagiert und auch in der Bevölkerung gelehrt werden, ist die Prognose dieser Patienten schlecht. Erstaunlicherweise sind die Ergebnisse der prähospitalen mit der intrahospitalen Reanimation hinsichtlich des Überlebens und des neurologischen Ergebnisses durchaus vergleichbar.
Neben der Evaluation von Risikofaktoren für das Erleiden des plötzlichen Herztodes sind in den letzten Jahren vor allem auch Daten zur Bedeutung der zeitgerechten Defibrillation für das Überleben der Patienten veröffentlicht worden.
In diesem Jahr beschäftigten sich nun zwei Analysen anhand der Daten von großen Registern intrahospital reanimierter Patienten in den USA mit a) der Bedeutung einer zeitlichen Verzögerung der Defibrillation (weniger oder mehr als 2 min bis zur ersten Defibrillation), und b) dem Einfluss der Tageszeiten bzw. des Wochentages auf das Überleben nach Herz-Kreislaufstillstand.
a) Wurde die erste Defibrillation innerhalb von 2 min nach Herz-Kreislaufstillstand durchgeführt, war die Letalität um knapp 20% geringer als bei Defibrillationszeiten von mehr als 2 min.
b) Trat der Herz-Kreislaufstillstand während der Kernarbeitszeit in der Woche auf, so verstarben weniger Patienten als nachts und am Wochenende.
Es zeigt sich übereinstimmend in beiden Arbeiten, wie unmittelbar Struktur und Prozess das Patientenergebnis – quo ad vitam – beeinflussen.
Offensichtlich sind strukturelle Voraussetzungen, wie die rasche Verfügbarkeit entsprechend ausgebildeter ärztlicher und nichtärztlicher Mitarbeiter, für das Überleben dieser Patienten von entscheidender Bedeutung.
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Janssens, U., Graf, J. Herz-Kreislaufstillstand im Krankenhaus. Intensivmed 45, 440–446 (2008). https://doi.org/10.1007/s00390-008-0903-1
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DOI: https://doi.org/10.1007/s00390-008-0903-1