Summary
Sudden cardiac death remains a major challenge that we are still facing today. The complexity of the trigger mechanisms makes it difficult to achieve a reliable identification of high-risk patients. Three suggestions are made that might help to overcome this epidemiological catastrophe “Sudden Cardiac Death”. 1. In patients with known heart disease risk stratification has to be improved by developing new methods to identify specifically those individuals, who are at risk for sudden rather than non-sudden cardiac death. 2. The general population contains an unknown proportion of individuals with advanced coronary disease, which is commonly asymptomatic. In these so called “normal population” classical risk stratification does not work. However, since there is a close relationship between the prevalence of risk factors for coronary disease and sudden death, a consequent treatment of risk factors should have a positive effect on sudden death rate as well. 3. The success rate of resuscitation has to be improved by strengthening each single link of the “chain of survival”. Laypersons trained in basic and advanced life support techniques have to play a much major role on this scene.
Zusammenfassung
Der plötzliche Herztod ist eine epidemiologische Katastrophe, der wir auch heute noch ziemlich hilflos gegenüber stehen. Die Komplexität der Auslösemechanismen erschweren die Identifizierung von Hochrisiko-Kollektiven im Allgemeinen und machen die zeitliche Vorhersagbarkeit eines solchen Ereignisses beim individuellen Patienten unmöglich. Mögliche Lösungsansätze: 1. Für Patienten mit bekannter Herzerkrankung (vor allem koronarer Herzerkrankung) gilt es die Methoden zur Risikostratifikation weiter zu verfeinern, um möglichst gezielt nur denjenigen eine effektive und dann auch kosteneffiziente Therapie (z. B. implantierbarer Defibrillator) zukommen zu lassen, die diese auch benötigen. 2. In der Gesamtbevölkerung korreliert die Inzidenz des plötzlichen Herztodes eng mit der Prävalenz der koronaren Herzerkrankung. Programme zur Reduktion plötzlicher Todesfälle sollten sich auf die Beeinflussung der koronaren Herzerkrankung und ihrer Risikofaktoren konzentrieren. 3. Wir benötigen bessere Reanimationsergebnisse. Es gilt daher, die einzelnen Glieder der Rettungskette zu verstärken. Die kurze Zeitschiene, in der erfolgreich Wiederbelebung möglich ist, rückt den Laienhelfer in das Zentrum der Rettungskaskade. Nur wenn es uns gelingt, großflächig Laien kompetent und nachhaltig in den Reanimationsablauf unter Einbeziehung der Defibrillation einzubinden, können wir zu Recht die Hoffnung haben, dass in Zukunft der plötzliche Herztod ein wenig von seinem Schrecken verlieren wird.
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Andresen, D. Epidemiologie des akuten Herz-Kreislaufstillstandes. Herzschr. Elektrophys. 16, 73–77 (2005). https://doi.org/10.1007/s00399-005-0466-9
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DOI: https://doi.org/10.1007/s00399-005-0466-9