Die neuen Reanimationsleitlinien 2005 des European Resuscitation Council

Abstract

The new CPR guidelines are based on a scientific consensus which was reached by 281 international experts. Chest compressions (100/min, 4-5 cm deep) should be performed in a ratio of 30:2 with ventilation (tidal volume 500 ml, Ti 1 s, FIO2 if possible 1.0). After a single defibrillation attempt (initially biphasic 150-200 J, monophasic 360 J, subsequently with the respective highest energy), chest compressions are initiated again immediately for 2 min. Endotracheal intubation is the gold standard; other airway devices may be employed as well depending on individual skills. Drug administration routes for adults and children: first choice IV, second choice intraosseous, third choice endobronchial [epinephrine dose 2-3x (adults) or 10x (pediatric patients) higher than IV]. Vasopressors: 1 mg epinephrine every 3-5 min IV. After the third unsuccessful defibrillation attempt amiodarone IV (300 mg); repetition (150 mg) possible. Sodium bicarbonate (1 ml/kg 8.4%) only in excessive hyperkalemia, metabolic acidosis, or intoxication with tricyclic antidepressants. Consider atropine (3 mg) and aminophylline (5 mg/kg). Thrombolysis during spontaneous circulation only in myocardial infarction or massive pulmonary embolism; during CPR only during massive pulmonary embolism. Cardiopulmonary bypass only after cardiac surgery, hypothermia or intoxication. Pediatrics: best improvement in outcome by preventing cardiocirculatory collapse. Alternate chest thumps and chest compression (infants), or abdominal compressions (>1-year-old) in foreign body airway obstruction. Initially five breaths, followed by chest compressions (100/min; approximately 1/3 of chest diameter): ventilation ratio 15:2. Treatment of potentially reversible causes (4 "Hs", "HITS": hypoxia, hypovolemia, hypo- and hyperkaliemia, hypothermia, cardiac tamponade, intoxication, thrombo-embolism, tension pneumothorax). Epinephrine 10 microg/kg IV or intraosseously, or 100 microg (endobronchially) every 3-5 min. Defibrillation (4 J/kg; monophasic oder biphasic) followed by 2 min CPR, then ECG and pulse check. Newborns: inflate the lungs with bag-valve mask ventilation. If heart rate<60/min chest compressions:ventilation ratio 3:1 (120 chest compressions/min). Postresuscitation phase: initiate mild hypothermia [32-34 degrees C for 12-24 h; slow rewarming (<0.5 degrees C/h)]. Prediction of CPR outcome is not possible at the scene; determining neurological outcome within 72 h after cardiac arrest with evoked potentials, biochemical tests and physical examination. Even during low suspicion for an acute coronary syndrome, record a prehospital 12-lead ECG. In parallel to pain therapy, aspirin (160-325 mg PO or IV) and in addition clopidogrel (300 mg PO). As antithrombin, heparin (60 IU/kg, max. 4000 IU) or enoxaparine. In ST-segment elevation myocardial infarction, define reperfusion strategy depending on duration of symptoms until PCI (prevent delay>90 min until PCI). Stroke is an emergency and needs to be treated in a stroke unit. A CT scan is the most important evaluation, ...

A Case of Severe QTc Prolongation During Targeted Temperature Management – What Can We Learn?

“…Although one case study showed initiation of torsades de pointes during TTM due to a QTc of 726 milliseconds, several studies have shown that QTc prolongation during TTM has no effect on the potentiation of fatal arrhythmias; however, they do not describe QTc intervals greater than 700 milliseconds. TTM has become the standard of care per all current major critical care guidelines including those from the International Liaison Committee on Resuscitation [ 11 ] and the European Resuscitation Council [ 12 ]. However, no guidelines exist regarding EKG monitoring during TTM, nor are there recommendations describing when TTM should be stopped in association with QTc prolongation.…”

Thrombolyse während der kardiopulmonalen Reanimation

“…B. während kurzer Phasen von ROSC (return of spontaneous circulation; Wiederherstellung eines Spontankreislaufs) -gezielt auf infarkttypische Veränderungen geprüft werden. Sowohl bei LE als auch bei AMI ist die medikamentöse Thrombolyse als klinische Routinetherapie nicht mehr wegzudenken und wird auch in den aktuell gültigen Leitlinien der European Society of Cardiology (ESC) und des European Resuscitation Councils (ERC) empfohlen [18]. In der Notfallmedizin hingegen galt die Thrombolyse lange Zeit als umstritten [19][20][21][22][23] und teilweise sogar als kontraindiziert [24] aus Sorge vor unbeherrschbaren BluObwohl die Thrombolyse während CPR momentan keine Standardtherapie darstellt, sollte sie leitlinienkonform bei hochgradigem Verdacht auf eine zugrunde liegende fulminante Lungenembolie sowie darüber hinaus in begründeten Einzelfällen dem Patienten nicht vorenthalten werden.…”

Thrombolyse während der kardiopulmonalen Reanimation

“…Sowohl bei LE als auch bei AMI ist die medikamentöse Thrombolyse als klinische Routinetherapie nicht mehr wegzudenken und wird auch in den aktuell gültigen Leitlinien der European Society of Cardiology (ESC) und des European Resuscitation Councils (ERC) empfohlen [40]. In der Notfallmedizin hingegen galt die Thrombolyse lange Zeit als umstritten [6,13,26,27,35] und teilweise sogar als kontraindiziert [31] aus Sorge vor unbeherrschbaren Blutungskomplikationen.…”