Kommentar zu den Leitlinien 2010 zur kardiopulmonalen Reanimation des European Resuscitation Council

Adults

Administer chest compressions (minimum 100/min, minimum 5 cm depth) at a ratio of 30:2 with ventilation (tidal volume 500–600 ml, inspiration time 1 s, F_IO₂ if possible 1.0). Avoid any interruptions in chest compressions. After every single defibrillation attempt (initially biphasic 120–200 J, monophasic 360 J, subsequently with the respective highest energy), chest compressions are initiated again immediately for 2 min independent of the ECG rhythm. Tracheal intubation is the optimal method for securing the airway during resuscitation but should be performed only by experienced airway management providers. Laryngoscopy is performed during ongoing chest compressions; interruption of chest compressions for a maximum of 10 s to pass the tube through the vocal cords. Supraglottic airway devices are alternatives to tracheal intubation. Drug administration routes for adults and children: first choice IV, second choice intraosseous (IO). Vasopressors: 1 mg epinephrine every 3–5 min IV. After the third unsuccessful defibrillation amiodarone (300 mg IV), repetition (150 mg) possible. Sodium bicarbonate (50 ml 8.4%) only for excessive hyperkaliemia, metabolic acidosis, or intoxication with tricyclic antidepressants. Consider aminophylline (5 mg/kgBW). Thrombolysis during spontaneous circulation only for myocardial infarction or massive pulmonary embolism; during on-going cardiopulmonary resuscitation (CPR) only when indications of massive pulmonary embolism. Active compression-decompression (ACD-CPR) and inspiratory threshold valve (ITV-CPR) are not superior to good standard CPR.

Children

Most effective improvement of outcome by prevention of full cardiorespiratory arrest. Basic life support: initially five rescue breaths, followed by chest compressions (100–120/min depth about one third of chest diameter), compression-ventilation ratio 15:2. Foreign body airway obstruction with insufficient cough: alternate back blows and chest compressions (infants), or abdominal compressions (children >1 year). Treatment of potentially reversible causes: (“4 Hs and 4 Ts”) hypoxia and hypovolaemia, hypokalaemia and hyperkalaemia, hypothermia, and tension pneumothorax, tamponade, toxic/therapeutic disturbances, thrombosis (coronary/pulmonary). Advanced life support: adrenaline (epinephrine) 10 µg/kgBW IV or IO every 3–5 min. Defibrillation (4 J/kgBW; monophasic or biphasic) followed by 2 min CPR, then ECG and pulse check.

Newborns

Initially inflate the lungs with bag-valve mask ventilation (p_AW 20–40 cmH₂O). If heart rate remains <60/min, start chest compressions (120 chest compressions/min) and ventilation with a ratio 3:1. Maintain normothermia in preterm babies by covering them with foodgrade plastic wrap or similar.

Postresuscitation phase

Early protocol-based intensive care stabilization; initiate mild hypothermia early regardless of initial cardiac rhythm [32–34°C for 12–24 h (adults) or 24 h (children); slow rewarming (<0.5°C/h)]. Consider percutaneous coronary intervention (PCI) in patients with presumed cardiac ischemia. Prediction of CPR outcome is not possible at the scene, determine neurological outcome <72 h after cardiac arrest with somatosensory evoked potentials, biochemical tests and neurological examination.

Acute coronary syndrome

Even if only a weak suspicion of an acute coronary syndrome is present, record a prehospital 12-lead ECG. In parallel to pain therapy, administer aspirin (160–325 mg PO or IV) and clopidogrel (75–600 mg depending on strategy); in ST-elevation myocardial infarction (STEMI) and planned PCI also prasugrel (60 mg PO). Antithrombins, such as heparin (60 IU/kgBW, max. 4000 IU), enoxaparin, bivalirudin or fondaparinux depending on the diagnosis (STEMI or non-STEMI-ACS) and the planned therapeutic strategy. In STEMI define reperfusion strategy depending on duration of symptoms until PCI, age and location of infarction.

Trauma

In severe hemorrhagic shock, definitive control of bleeding is the most important goal. For successful CPR of trauma patients a minimal intravascular volume status and management of hypoxia are essential. Aggressive fluid resuscitation, hyperventilation and excessive ventilation pressure may impair outcome in patients with severe hemorrhagic shock.

Training

Any CPR training is better than nothing; simplification of contents and processes is the main aim.     

Leitlinien des European Resuscitation Council (ERC) zur kardiopulmonalen Reanimation 2021: Update und Kommentar

Die Anaesthesiologie - Jüngst wurden die europäischen Leitlinien zur kardiopulmonalen Reanimation verabschiedet, die in 12&nbsp;Kapitel unterteilt sind. Erstmals wurden die Themen...     

Erratum zu: Kurzdarstellung. Kapitel 1 der Leitlinien zur Reanimation 2015 des European Resuscitation Council

Notfall + Rettungsmedizin -     

Erratum zu: Kreislaufstillstand in besonderen Situationen. Kapitel 4 der Leitlinien zur Reanimation 2015 des European Resuscitation Council

Notfall + Rettungsmedizin -     

Leitlinien zur Reanimation 2005 – Umsetzung im Rettungsdienst

Guidelines become effective only when they are adhered to during the course of everyday work. The question that then arises is how current scientific knowledge of cardiopulmonary resuscitation is put into practice by the professionals involved in emergency medical services. To begin with, a German translation of the complete text of the 2005 guidelines issued by the European Resuscitation Council was published promptly. Subsequently the guidelines had to be adopted nationwide by the German Medical Association as well as locally. At the regional level new concepts for organization and process structures had to be established. Theoretical and practical courses acquainted participants with the changes in resuscitation workflows. As part of quality management, documentation was instituted, analysis performed, and feedback gathered regarding implementation of the new clinical guidelines into practice, especially during the first year. By constantly updating the workflow, the goal of improving the patients’ outcome after resuscitation will continue to be pursued.     

Die neuen Reanimationsleitlinien 2005 des European Resuscitation Council

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, F_IO₂ 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 2–3× (adults) or 10× (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; ~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 µg/kg IV or intraosseously, or 100 µg (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°C for 12–24 h; slow rewarming (<0.5°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, MRT may replace a CT scan. After hemorrhage exclusion, thrombolysis within 3 h of symptom onset (0.9 mg/kg rt-PA IV; max 90 mg within 60 min, 10% of the entire dosage as initial bolus, no aspirin, no heparin within the first 24 h). In severe hemorrhagic shock, definite control of bleeding is the most important goal. For successful CPR of trauma patients, a minimal intravascular volume status and management of hypoxia are essential. Aggressive fluid resuscitation, hyperventilation, and excessive ventilation pressure may impair outcome in severe hemorrhagic shock. Despite bad prognosis, CPR in trauma patients may be successful in select cases. Any CPR training is better than nothing; simplification of contents and processes remains important.     

Leitlinien zur kardiopulmonalen Reanimation

Ohne Zusammenfassung     

Ethische Aspekte in den Leitlinien zur Reanimation

The “Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care—A Consensus on Science” were published in 2000. The content not only consists of evidence-based therapy strategies for cardiopulmonary resuscitation (CPR), but also a 10-page introduction to the ethical aspects of CPR. General ethical principles such as “beneficence,” “nonmaleficence,” “autonomy,” and “justice” are widely accepted. Their priority might vary among different cultures and regions. Especially focusing on CPR the ethical aspects of patient autonomy (advance directive, “do not attempt resuscitation order”), futility (interventions that cannot increase length of life or quality of life), and the criteria to withhold or to withdraw CPR are of interest. In addition concepts for working with the patient’s family members are described (presence of relatives during resuscitation efforts; notifying survivors of the death of their loved one).     

Ausbildungskonzepte des European Resuscitation Council (ERC)

The European Resuscitation Council (ERC) is the interdisciplinary professional association in Europe for resuscitation and medical emergencies. The mission of the ERC is to save lives by continuously improving the standard in resuscitation. Based on international consensus, the ERC thus formulates guidelines for cardiopulmonary resuscitation, which conform to current scientific knowledge and European requirements. In addition, it offers programs for basic and advanced training and continuing education for anyone who may be confronted by a situation in which resuscitation is needed.     

Leitlinien zur Reanimation 2005 – Was haben sie bewirkt, was gibt es Neues?

Under coordination of the International Liason Committee on Resuscitation (ILCOR) for several years experts all over the world allocated resuscitation measures by their level of evidence, that would lead to improved survival after cardiac arrest. Derived from the “Consensus of Science” in 2005 the European Resuscitation Council (ERC) published the reedited guidelines for cardiopulmonary resuscitation. The most important effect of the guideline changes is that external cardiac compressions can be performed for longer periods without interruptions. This has been possible since resuscitation measures that have not shown to improve survival now have to be done less frequently. Hereby it seems to be easier to perform cardiopulmonary resuscitation more efficiently and structured. But it also had to be noticed that some changes, e.g. immediate continuation of external cardiac compressions following defibrillation, are more difficult to teach. New conclusions indicate that further guideline changes can be expected.     

Leitlinien zur Diagnostik und Therapie des Nierenparenchymkarzinoms

Ohne Zusammenfassung     

Deutsche Leitlinien zur Diagnostik des benignen Prostatasyndroms

The new version of the German guidelines for assessing benign prostatic hyperplasia (BPH) was written in 2006 and 2007 by experts of the BPH working group on behalf of the German Association of Urology and Federation of German Urologists. The full version is expected to be published in 2008. Recommendations for assessing BPH were modified and updated and include patient history, symptom questionnaires, physical examination, urine analysis, prostate-specific antigen, uroflowmetry, ultrasound examination of the urinary bladder (including postvoid residual urine), and ultrasound examination of the upper urinary tract or creatinine measurement. Optional tests are voiding diary, pressure-flow studies, ultrasound measurement of detrusor wall thickness, urethrocystography, and urethrocystoscopy. For the first time, tests for the differential diagnosis of bladder symptoms and BPH are described. Furthermore, the latest knowledge was added on disease progression, indications for urodynamic assessment, and ultrasound measurement of detrusor wall thickness for evaluating bladder outlet obstruction. International quality standards were applied in order to increase the guidelines' value; all tests were judged using the levels of evidence and grades of recommendation of the U.S. Department of Health and Human Services classification.     

The new 2005 resuscitation guidelines of the European Resuscitation Council: comments and supplements

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, MRT may replace a CT scan. After hemorrhage exclusion, thrombolysis within 3 h of symptom onset (0.9 mg/kg rt-PA IV; max 90 mg within 60 min, 10% of the entire dosage as initial bolus, no aspirin, no heparin within the first 24 h). In severe hemorrhagic shock, definite control of bleeding is the most important goal. For successful CPR of trauma patients, a minimal intravascular volume status and management of hypoxia are essential. Aggressive fluid resuscitation, hyperventilation, and excessive ventilation pressure may impair outcome in severe hemorrhagic shock. Despite bad prognosis, CPR in trauma patients may be successful in select cases. Any CPR training is better than nothing; simplification of contents and processes remains important.     

Leitlinien der Deutschen Urologen zur Diagnostik des BPH-Syndroms

Ohne Zusammenfassung