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Intensivtherapie und Prognose des akuten Kreislaufstillstandes

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Zusammenfassung

Anhand von 115 im Zeitraum von 2 1/2 Jahren beobachteten Episoden von akutem Kreislaufstillstand bei 90 Patienten werden die Kriterien und Behandlungserfolge der Intensivtherapie des akuten Kreislaufstillstandes dargelegt. Während die Basis-Therapie mit externer Herzmassage, künstlicher Beatmung, Natriumbicarbonatinfusionen und elektrischer Defibrillation eindeutig feststeht, bietet die medikamentöse Führung noch immer Probleme. Zehn eigene Verlaufsbeobachtungen zeigen, daß betaadrenergische Sympathomimetica auch bei bestimmten Fällen tachysystolischer Herzrhythmusstörungen günstig wirken. Der Versuch der elektrischen Stimulation des Herzens mit einer extern angelegten epikardialen Schrittmachersonde bei akutem Kreislaufstillstand durch Asystolie oder Bradykardie führte in keinem von 8 Fällen zum Erfolg. Für die Früh- und Spätprognose sind bei adäquater Therapie in erster Linie Art und Schwere des Grundleidens sowie der morphologisch funktionelle Zustand lebenswichtiger Organe bei Einsetzen des plötzlichen Kreislaufstillstandes verantwortlich. Bei Kammerflimmern und Kammerflattern waren deutlich bessere Resultate zu erzielen, als beim akuten Kreislaufstillstand durch Asystolie. Von den 90 Patienten überlebten 12 länger als 4 Wochen (13%), 9 (10%) konnten entlassen werden und sind zum Zeitpunkt der Publikation ohne Nachwirkungen des akuten Kreislaufstillstandes. Es wird auf die Bedeutung einer lückenlosen Beobachtung Schwerstkranker und die Beachtung prämonitorischer Zeichen zur Verhütung des akuten Kreislaufstillstandes hingewiesen.

Summary

Criteria and therapeutic success of intensive therapy of cardiac arrests are evaluated in 115 episodes observed in 90 patients over a period of 2 1/22 years. While basic therapy with external cardiac massage, artificial ventilation, infusion of sodium bicarbonate and electrical defibrillation is generally agreed upon, the choice of further drugs is still problematic. It is shown in 10 cases that under certain conditions even in ventricular fibrillation and ventricular tachycardia beta-receptor stimulating drugs are indicated. Electrical stimulation of the heart by an external epicardial pacemaker was unsuccessful in all of eight cases with complete asystoly or bradycardia. Immediate and long term results of cardiac arrests with adequate treatment primarely depends on the extend of the underlying disease as well as on the condition of all vital organs at the time of onset of the arrest. Ventricular fibrillation and -flutter had a better prognosis than asystoly. Twelve out of the ninety patients lived longer than four weeks after the arrest (13%). Nine of these are still living at the time of publication with an observation time from three months to two years. The chance of improving therapeutic results with intensive care lie mainly in preventing rather than curing complications such as cardiac arrests.

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Authors and Affiliations

  1. II. Medizinische Universitätsklinik und Poliklinik Mainz, Germany

    H.-P. Schuster, P. Baum & P. Schölmerich

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  1. H.-P. Schuster
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  2. P. Baum
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  3. P. Schölmerich
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Professor Dr.H. E. Bock zum 65. Geburtstag.

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Schuster, HP., Baum, P. & Schölmerich, P. Intensivtherapie und Prognose des akuten Kreislaufstillstandes. Klin Wochenschr 47, 4–16 (1969). https://doi.org/10.1007/BF01747423

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