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Kardiokompressionssysteme zur Reanimation im akuten Kreislaufstillstand

Cardiocompression systems for resuscitation in acute cardiac arrest

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Zusammenfassung

Im Rahmen der kardiopulmonalen Reanimation wird beim akuten Herzkreislaufstillstand eine Herzdruckmassage mit einer Frequenz 100/min und einer Kompressionstiefe von 5 cm empfohlen. Damit dies im präklinischen Kreislaufstillstand sicher gewährleistet werden kann, haben in den letzten Jahren sog. nichtinvasive, automatische Kardiokompressionssysteme Einzug in die Notfallmedizin gehalten. In Deutschland sind derzeit das LUCAS™- sowie das AutoPulse™-System mit CE-Zeichen verfügbar. Beide Systeme sind batteriebetrieben für den mobilen Einsatz geeignet und erleichtern den Patiententransport unter ununterbrochener Kardiokompression. Ihre Vorteile liegen in einer definierten Kompressionstiefe und Geschwindigkeit sowie einer geringeren Gefährdung des Personals bei Transportfahrten. Während passive Systeme zur Kardiokompression/-dekompression einen Überlebensvorteil unter prähospitalen Bedingungen zeigen konnten, liegen für aktive, automatische Kardiokompressionssysteme noch keine Studien vor, die eine generelle Empfehlung für ihre Verwendung im Rettungsdienst geben würden. Für ihren Einsatz bei ausgewählten Patienten im Herzkatheterlabor besteht eine Empfehlung, da neben dem Strahlenschutz für das Personal diese Systeme eine invasive Diagnostik und Therapie erst ermöglichen. Für den erfolgreichen Einsatz sind ein entsprechendes Training des Personals sowie eine sorgfältige Patientenauswahl notwendig. Derzeit laufende, multizentrische Studien zum präklinischen Kreislaufstillstand werden in Zukunft die notwendige Evidenz und Datenbasis zur Identifikation von Patientengruppen schaffen, welche vom Einsatz automatischer Kardiokompressionssysteme profitieren.

Abstract

Recently published guidelines recommend external cardiocompression at a frequency of 100 per minute and a depth of 5 cm for out-of-hospital circulatory arrest patients. In these settings, automated cardiocompression devices can provide standardized patient support in preclinical emergency medicine. The LUCAS™ and the AutoPulse™, both CE-labelled systems, are currently available in Germany. Besides defined compression depth and frequency, both systems provide a better protection of the emergency transport personnel. Non-automated cardiocompression-decompression devices for augmented manual chest compression recently proved a survival benefit in out-of-hospital cardiac arrest. However, due to lack of evidence, the use of automated thorax compression devices in this setting is still under discussion. The use of active compression devices is recommend in selected patients in the catheter laboratory as it reduces radiation exposure of the personnel and facilitates invasive angiographic and therapeutic procedures in acute circulatory arrest. Successful use of active chest compression devices requires intense training and appropriate indications. Currently ongoing randomized trials in out-of-hospital resuscitation will provide sufficient data for careful patient selection and evidence-based use of automated mechanical chest compression devices in the future.

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  1. Klinik für Innere Medizin I, Friedrich-Schiller-Universität, Erlanger Allee 101, 07747, Jena, Deutschland

    M. Ferrari, A. Lauten & H.R. Figulla

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  1. M. Ferrari
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  2. A. Lauten
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  3. H.R. Figulla
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Correspondence to M. Ferrari.

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Ferrari, M., Lauten, A. & Figulla, H. Kardiokompressionssysteme zur Reanimation im akuten Kreislaufstillstand. Notfall Rettungsmed 14, 618–623 (2011). https://doi.org/10.1007/s10049-011-1416-1

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