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Vorgehen nach präklinischem Herz-Kreislauf-Stillstand

Ist ein sofortiger Transfer ins Herzkatheterlabor dem Kurzcheck im Schockraum vorzuziehen?

Procedure following out-of-hospital cardiac arrest

Should immediate transfer to the cardiac catheter laboratory be preferred over a quick check in the shock room?

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Zusammenfassung

Die Mortalität beim präklinischen Herz-Kreislauf-Stillstand ist nach wie vor sehr hoch. Seine Ursachen können vielfältig sein. Am häufigsten ist zwar immer noch der Myokardinfarkt, dieser ist aber in den letzten Jahren als Ursache deutlich zurückgegangen. Für den Myokardinfarkt ist die sofortige Intervention der Goldstandard, bei extrakardialen Ursachen kann der Umweg über eine Intervention ohne weitere andere Diagnostik aber verhängnisvoll sein. Es ist deshalb Gegenstand der Diskussion, ob die sofortige Verbringung des Patienten in das Herzkatheterlabor und gegebenenfalls die Intervention und Anlage eines „extracorporeal life support“ (ECLS) sinnvoll ist oder ob bei Ankunft des Patienten ein interdisziplinäres konservatives Schockraumteam aus Kardiologen, Notfall- oder Intensivmedizinern in einem Kurzcheck die weitere Diagnostik und Therapie des Patienten festlegen und gegebenenfalls weitere Fachexperten hinzuziehen soll. Der Beitrag soll das Pro und Kontra der beiden Vorgehensweisen beleuchten.

Abstract

Mortality following out-of-hospital cardiac arrest (OHCA) remains high and may have various causes. Although myocardial infarction is still the most frequent cause of cardiac arrest, it has declined significantly in recent years. Immediate intervention is the gold standard in patients with acute myocardial infarction. However, in patients with non-cardiac causes of OHCA, a detour via the cardiac catheter laboratory, thereby delaying further diagnosis, can be fatal. The optimal strategic algorithm in this clinical scenario is unclear. Thus it is the subject of discussion whether immediate transfer of the patient to the catheter laboratory or an initial diagnostic and therapeutic work-up by the interdisciplinary conservative shock room team of cardiologists, emergency or intensive care physicians is the best strategy in patients following OHCA. Therefore, this review focuses on existing data and recommendations and tries to present a strategic algorithm.

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Authors and Affiliations

  1. Zentrale Notaufnahme, Schwarzwald-Baar Klinikum GmbH, Klinikstr. 11, 78052, Villingen-Schwenningen, Deutschland

    Bernhard Kumle

  2. Medizinische Klinik I, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    Martin Orban

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Correspondence to Bernhard Kumle or Martin Orban.

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Interessenkonflikt

B. Kumle und M. Orban geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Bernhard, Düsseldorf

H. Dormann, Fürth

C. Waydhas, Bochum

M. Orban und B. Kumle teilen sich die Erstautorenschaft. M. Orban hat den Pro-Teil dieses Beitrags verfasst. B. Kumle schrieb den Kontra-Teil.

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Kumle, B., Orban, M. Vorgehen nach präklinischem Herz-Kreislauf-Stillstand. Notfall Rettungsmed 22, 696–703 (2019). https://doi.org/10.1007/s10049-018-0547-z

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