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Mechanische Reanimationshilfen

Mechanical resuscitation assist devices

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Zusammenfassung

Hochgerechnet erleiden in Deutschland pro Jahr zwischen 100.000 und 160.000 Menschen einen plötzlichen Herztod außerhalb des Krankenhauses. Die Häufigkeit einer Reanimationsbehandlung („cardiopulmonary resuscitation“, CPR) nach plötzlichem Herztod beträgt je nach Notarztdienst 30–90 begonnene Reanimationsmaßnahmen/100.000 Einwohner und Jahr. Hierbei sind die Basismaßnahmen – Thoraxkompression und Beatmung – die Kernstücke der CPR. Frühzeitiger Beginn und Qualität der Ausführung sind entscheidend für den Reanimationserfolg. Selbst professionelle Helfer sind nicht immer in der Lage, die notwendige Qualität der CPR-Maßnahmen zu gewährleisten. Konsequenterweise sind in den letzten Jahren viele mechanische Reanimationshilfen entwickelt worden, um die Thoraxkompression und den daraus resultierenden passiven Notkreislauf zu optimieren. Im vorliegenden Leitthemenbeitrag werden die derzeit in Deutschland verfügbaren mechanischen Reanimationshilfen vorgestellt, erläutert und wissenschaftlich im Kontext mit der verfügbaren Literatur bewertet.

Abstract

In Germany 100,000–160,000 people suffer from out-of-hospital cardiac arrest (OHCA) annually. The incidence of cardiopulmonary resuscitation (CPR) after OHCA varies between emergency ambulance services but is in the range of 30–90 CPR attempts per 100,000 inhabitants per year. Basic life support (BLS) involving chest compressions and ventilation is the key measure of resuscitation. Rapid initiation and quality of BLS are the most critical factors for CPR success. Even healthcare professionals are not always able to ensure the quality of CPR measures. Consequently in recent years mechanical resuscitation devices have been developed to optimize chest compression and the resulting circulation. In this article the mechanical resuscitation devices currently available in Germany are discussed and evaluated scientifically in context with available literature. The ANIMAX CPR device should not be used outside controlled trials as no clinical results have so far been published. The same applies to the new device Corpuls CPR which will be available on the market in early 2014. Based on the current published data a general recommendation for the routine use of LUCAS™ and AutoPulse® CPR cannot be given. The preliminary data of the CIRC trial and the published data of the LINC trial revealed that mechanical CPR is apparently equivalent to good manual CPR. For the final assessment further publications of large randomized studies must be analyzed (e.g. the CIRC and PaRAMeDIC trials). However, case control studies, case series and small studies have already shown that in special situations and in some cases patients will benefit from the automatic mechanical resuscitation devices (LUCAS™, AutoPulse®). This applies especially to emergency services where standard CPR quality is far below average and for patients who require prolonged CPR under difficult circumstances. This might be true in cases of resuscitation due to hypothermia, intoxication and pulmonary embolism as well as for patients requiring transport or coronary intervention when cardiac arrest persists. Three prospective randomized studies and the resulting meta-analysis are available for active compression-decompression resuscitation (ACD-CPR) in combination with an impedance threshold device (ITD). These studies compared ACD-ITD-CPR to standard CPR and clearly demonstrated that ACD-ITD-CPR is superior to standard CPR concerning short and long-term survival with good neurological recovery after OHCA.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Fischer, M. Breil, M. Ihli, M. Messelken, S. Rauch geben an, dass kein Interessenkonflikt besteht. J.-C. Schewe erhielt Referentenhonorare und Reisekostenerstattungen für wissenschaftliche Vortragstätigkeiten von der Fa. ZOLL Medical Deutschland. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Fall von nichtmündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor. Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Operative Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinik am Eichert der ALB FILS Kliniken, Eicherstr. 3, 73035, Göppingen, Deutschland

    M. Fischer, M. Messelken & S. Rauch

  2. Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn (AöR), Bonn, Deutschland

    M. Breil & J.-C. Schewe

  3. Medizinische Klinik, Helfenstein Klinik der ALB FILS Kliniken, Geislingen, Deutschland

    M. Ihli

Authors
  1. M. Fischer
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  2. M. Breil
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  3. M. Ihli
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  4. M. Messelken
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  5. S. Rauch
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  6. J.-C. Schewe
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Corresponding author

Correspondence to M. Fischer.

Additional information

Die vorliegende Arbeit „Mechanische Reanimationshilfen“ ist als Aktualisierung und Update des Beitrags „Mechanische Reanimationsgeräte“ (Notfall Rettungsmed 2010,13:189–196) zu verstehen.

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Fischer, M., Breil, M., Ihli, M. et al. Mechanische Reanimationshilfen. Anaesthesist 63, 186–197 (2014). https://doi.org/10.1007/s00101-013-2265-8

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  • DOI: https://doi.org/10.1007/s00101-013-2265-8

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