Zusammenfassung
Hintergrund
Seit 2003 empfehlen die internationalen Reanimationsleitlinien (International Liaison Committee on Resuscitation, ILCOR) als Therapie nach erfolgreicher Reanimation bei Kammerflimmern und bestehendem Koma bei Erwachsenen die Kühlung des Patienten auf eine Körpertemperatur von 32–34° C über 12–24 h.
Studien
Basis für diese Empfehlung waren 2 randomisierte Studien, die eine Prognoseverbesserung durch Hypothermie nach Reanimation beschrieben. Im Jahr 2013 wurden 2 neue große Untersuchungen vorgestellt, die das Konzept der Hypothermie nach Reanimation nicht unterstützen. In der einen Studie führte eine raschere Temperatursenkung durch Infusion kalter Lösung nicht zu einer Prognoseverbesserung. In der anderen Arbeit fand sich kein Prognoseunterschied, wenn reanimierte Patienten auf 33 oder 36° C gekühlt wurden.
Schlussfolgerung
Unter Berücksichtigung des derzeitigen Kenntnisstandes müssen die Leitlinienempfehlungen als vorschnell angesehen werden. Man hätte allenfalls die Hypothermie bei den reanimierten Patienten empfehlen können, die die Ein- und Ausschlusskriterien der HACA-Studie erfüllen. Das gesamte Konzept der Hypothermie nach Reanimation sollte durch entsprechende Studien weiter erforscht werden.
Abstract
Background
Since 2003 the international resuscitation guidelines from the International Liaison Committee on Resuscitation (ILCOR) recommend hypothermia to a body temperature of 32–34° C for 12–24 h as therapy after successful resuscitation from ventricular fibrillation and existing coma in adults.
Studies
The basis for this recommendation were two randomized studies that described a favorable outcome by hypothermia after resuscitation. In 2013 two new large studies were presented that do not support the concept of hypothermia after resuscitation. In one trial a more rapid decrease in temperature by infusion of cold solution did not result in an improved prognosis. The other study did not find a different outcome when resuscitated patients were cooled to a body temperature of 33° C or 36° C.
Conclusions
Taking into account the present state of knowledge the guideline recommendations must be regarded as premature. Hypothermia may be recommended in resuscitated patients who meet the inclusion and exclusion criteria of the HACA trial. The whole concept of hypothermia after resuscitation should be further explored by appropriate studies.
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Einhaltung ethischer Richtlinien
Interessenkonflikt. H.H. Klein gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Diese Arbeit ist mit großem Dank meinen prägenden medizinischen Lehrern gewidmet: Prof. Dr. med. Wolfgang Schaper, Prof. Dr. med. Karl-Ludwig Neuhaus und Prof. Dr. med. Heinrich Kreuzer.
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Klein, H. Therapeutische Hypothermie nach Reanimation. Kardiologe 8, 472–476 (2014). https://doi.org/10.1007/s12181-014-0594-8
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DOI: https://doi.org/10.1007/s12181-014-0594-8