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Sind initialer pH- und Laktatwert nach kardiopulmonaler Wiederbelebung immer entscheidend?

Are the initial pH and the lactate values after cardiopulmonary resuscitation always crucial?

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Zusammenfassung

Aufgrund eines akuten Koronarsyndroms erlitt ein 52-jähriger Patient ein therapierefraktäres Kammerflimmern. Es wurde unmittelbar mit einer Laienreanimation begonnen. Unter Fortführung der kardiopulmonalen Reanimationsmaßnahmen sowie nach repetitiven Defibrillationen und intravenöser Gabe von Amiodaron konnte temporär eine Wiederherstellung der Kreislaufverhältnisse etabliert werden. Bei persistierendem Kammerflimmern wurde die Indikation zur mechanischen Reanimation mittels LUCAS®-Device gestellt und der Patient nach insgesamt 90-minütiger Reanimationsdauer zur Notfallkoronarangiographie vorgestellt. Es zeigte sich eine ausgeprägte Laktatacidose mit einem pH-Wert von 6,7 in der initialen Blutgasanalyse (BGA), weshalb im multiprofessionellen Team die Entscheidung gegen eine extrakorporale Membranoxygenierung getroffen wurde. Nach Mehrfachstenting der rechten Koronararterie (RCA) und der linksseitigen Koronararterie (LAD) unter fortlaufender mechanischer Reanimation sowie anschließender therapeutischer Hypothermie konnte der Patient rasch extubiert werden. Der Patient wies im Verlauf keinerlei neurologische Defizite auf.

Abstract

A 52-year-old man suffered an out-of-hospital cardiac arrest (OHCA) and bystander reanimation was immediately started. The initial electrocardiogram indicated ventricular fibrillation. After repetitive defibrillations as well as intravenous administration of amiodarone, a temporary return of spontaneous circulation (ROSC) could be established. Due to unstable cardiovascular conditions with recurrence of ventricular fibrillation, mechanical resuscitation with the help of the LUCAS™ device was initiated, and the patient was admitted to our hospital for emergency coronary angiography after a cumulative period of approximately 90 min. The initial blood gas analysis displayed a significant lactate acidosis with a pH value of 6.7. Therefore, in a multidisciplinary team, the decision was made against an extracorporeal membrane oxygenation and for a coronary angiography under continuation of mechanical resuscitation. After multiple stenting of the right coronary artery and left anterior descending coronary artery, permanent ROSC could be established. The patient was admitted to our intensive care unit, where he was further treated according to the S3-guideline for infarct-related cardiogenic shock. In the course of time, the patient was quickly extubated without any neurological deficits.

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  1. Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    C. Hohmann, R. Pfister &  G. Michels

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  1. C. Hohmann
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  2. R. Pfister
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  3. G. Michels
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Correspondence to G. Michels.

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C. Hohmann, R. Pfister und G. Michels geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben.

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R. Riessen, Tübingen

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Hohmann, C., Pfister, R. & Michels, G. Sind initialer pH- und Laktatwert nach kardiopulmonaler Wiederbelebung immer entscheidend?. Med Klin Intensivmed Notfmed 114, 561–566 (2019). https://doi.org/10.1007/s00063-018-0432-z

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  • DOI: https://doi.org/10.1007/s00063-018-0432-z

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