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Kardiopulmonale Reanimation durch einen professionellen Helfer

Vergleich verschiedener Positionen am Modell

Cardiopulmonary resuscitation performed by one single professional rescuer

A simulation study to compare different positions

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Zusammenfassung

Hintergrund

Die Leitlinien zur kardiopulmonalen Reanimation (CPR) aus dem Jahr 2005 beinhalten keine Aussage zur konkreten Durchführung der Basismaßnahmen (Basic Life Support, BLS) durch einen einzelnen Helfer, der mit einem Beatmungsbeutel ausgestattet ist. Denkbar sind drei Positionen: Thoraxkompressionen und Beatmung aus der Position hinter dem Kopf des Patienten (Überkopf-CPR), aus der Position seitlich am Patienten (laterale CPR) oder im Wechsel seitliche Thoraxkompressionen und Überkopf-Beatmung (Wechsel-CPR). Das Ziel dieser Studie war der Vergleich der Qualität des BLS dieser drei Positionen.

Methoden

Nach standardisierter Einführung und praktischer Übung führten 117 Studierende der Medizin mit geringen Vorkenntnissen bezüglich der kardiopulmonalen Reanimation für jeweils 2 min abwechselnd 30 Thoraxkompressionen und 2 Beatmungen mit Beatmungsbeutel in den verschiedenen Positionen in randomisierter Reihenfolge am Patientensimulator durch.

Ergebnisse

Die Überkopf-CPR ergab signifikant mehr Thoraxkompressionen (im Median 139 in 2 min), signifikant mehr Beatmungen (8 in 2 min) und eine signifikant kürzere Zeit ohne Thoraxkompressionen (41 s) verglichen mit der lateralen CPR (136; 8; 42 s) und der Wechsel-CPR (125; 7; 46 s). Die Überkopf-CPR führte zu signifikant mehr korrekten Beatmungen (4 in 2 min) und nichtsignifikant weniger korrekten Thoraxkompressionen (61 in 2 min) verglichen mit der lateralen CPR (3; 82) und der Wechsel-CPR (3; 80).

Schlussfolgerung

Auch wenn die statistischen Unterschiede zwischen den Positionen klinisch nicht unbedingt relevant sind, so ist die Überkopf-CPR nach unseren Daten eine gute Möglichkeit für den Fall eines einzelnen Helfers, der einen Beatmungsbeutel zur Verfügung hat und in der Beutel-Masken-Beatmung geübt ist.

Abstract

Background

The 2005 guidelines for cardiopulmonary resuscitation (CPR) do not define the rescuer’s position while performing basic life support (BLS) by one single rescuer with a bag-valve mask device. Three different methods are possible: chest compressions and ventilations from over the head of the casualty (over-the-head CPR), from the side of the casualty (lateral CPR) and chest compressions from the side and ventilations from over-the-head of the casualty (alternating CPR). The aim of this study was to compare the quality of BLS of these three methods.

Methods

After a standardized theoretical introduction and hands-on training 117 medical students with limited knowledge and training in CPR participated in this study. Students were randomized in a cross-over design and performed a 2 min CPR test for each position on a manikin.

Results

Over-the-head CPR led to significantly more chest compressions (median 139 per 2 min), significantly higher number of inflations (8 per 2 min) and significantly shorter hands-off time (41 s) compared to lateral (136; 8; 42 s) and alternating CPR (125; 7; 46 s). Over-the-head CPR resulted in significantly more correctly performed ventilations (4 per 2 min) and non-significantly fewer correct chest compressions (61 per 2 min) compared to lateral (3; 82) and alternating CPR (3; 80).

Conclusions

Even though the statistical differences between the positions might not be of clinical relevance, according to the data over-the-head CPR is a good option for a single rescuer equipped with a bag-valve mask device and who is familiar with bag-valve-mask ventilation.

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  1. Klinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    S. Maisch, M. Issleib, B. Kuhls, J. Mueller, G.-Y.M. Kang, A.E. Goetz & G.N. Schmidt

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  1. S. Maisch
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  2. M. Issleib
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  3. B. Kuhls
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  4. J. Mueller
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  5. G.-Y.M. Kang
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  6. A.E. Goetz
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  7. G.N. Schmidt
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Correspondence to S. Maisch.

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Maisch, S., Issleib, M., Kuhls, B. et al. Kardiopulmonale Reanimation durch einen professionellen Helfer. Notfall Rettungsmed 14, 662–668 (2011). https://doi.org/10.1007/s10049-010-1391-y

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