Fettembolie und kardiopulmonale Reanimation

Ohne Zusammenfassung     

Herz-Kreislauf-Stillstand und kardiopulmonale Reanimation auf der herzchirurgischen Intensivstation

Providers of critical-care medicine implement cardiopulmonary resuscitation as a central part of their work. Though many guidelines exist and efforts to train medical personnel have been made in recent decades, morbidity and mortality of patients undergoing cardiopulmonary resuscitation is still high. Circulatory arrest after cardiac surgery is mainly caused by pericardial tamponade or myocardial ischemia. Though resuscitation of patients after cardiac surgery follows common guidelines, considerations of specific emergency procedures (i. e., thoracotomy) have to be made.     

Erweiterte kardiopulmonale Reanimation in besonderen Situationen

Based on the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR), guidelines were published for managing basic and advanced life-saving procedures in the event of cardiac arrest. The fact that special circumstances sometimes must be considered in patient treatment resulted in a separate chapter. This first part of a two-part article reviews essential information as well as necessary modifications of the standard advanced life support algorithm in cases of life-threatening drowning, asthma, anaphylaxis, and poisoning. The second part will deal with electrolyte disorders, hypothermia, electrical emergencies, trauma, cardiac arrest during pregnancy, and cardiac surgery.     

Erfolgreiche kardiopulmonale Reanimation in Bauchlage

In certain surgical positions standard cardiopulmonary resuscitation (CPR) cannot be carried out. It is sometimes impossible or time-consuming to establish a supine position without increasing the no-flow-time and therefore creating a negative outcome of the patient. The case of CPR in a prone position during an emergency evacuation of a cerebellar hematoma is reported. The resuscitation was initiated in the prone position to decrease the no-flow-time. This was very effective because the return of spontaneous circulation (ROSC) started before turning the patient to the supine position. Resuscitation in the prone position in this case was equally as effective as in the traditional supine position.     

Extrakorporale kardiopulmonale Reanimation (eCPR)

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Reanimation im Neugeborenen- und Kindesalter

In comparison to cardiopulmonary resuscitation (CPR) in adults, emergency situations in babies and children which eventually end in cardiopulmonary resuscitation measures constitute a particular challenge for the emergency physician. Paediatric emergencies are always a mental challenge, in particular, if the physician lacks a sufficient paediatric case load during his daily routine working schedule. Especially in CPR situations it has to be emphasised rather than being ignored that children are not “small adults”. In spring 2000, major international resuscitation organisations (International Liaison Committee on Resuscitation, ILCOR) developed clear cut algorithms and guidelines for basic and advanced life support in babies and children and for resuscitation of babies at birth which are presented and discussed.     

Kardiopulmonale Reanimation nach Heroinintoxikation und Hypothermie

We present the case of a 21-year-old female drug addict with severe accidental hypothermia (core body temperature 27.5 degrees C) and cardiorespiratory arrest. After successful cardiopulmonary resuscitation the patient was actively internally rewarmed without the use of extracorporal circulation. Although at the first clinical presentation the patient appeared to be dead, an excellent neurological outcome was achieved. This case report reviews the epidemiology, pathophysiology, prognostic markers and the therapeutic approaches of severe hypothermia.     

Berichte über Kreislaufstillstände und kardiopulmonale Reanimationen

Outcome following cardiac arrest and cardiopulmonary resuscitation is dependent on critical interventions, particularly early defibrillation, effective chest compressions, and advanced life support. Utstein-style definitions and reporting templates have been used extensively in published studies of cardiac arrest, which has led to a greater understanding of the elements of resuscitation practice and progress towards an international consensus on science and resuscitation guidelines. Despite the development of Utstein templates to standardize research reports on cardiac arrest, international registries have yet to be developed. In April 2002, a task force from ILCOR met in Melbourne, Australia, to review worldwide experience with the Utstein definitions and reporting templates. The task force revised the core reporting template and definitions by consensus. Care was taken to build on previous definitions, changing data elements and operational definitions only on the basis of published data and experience derived from those registries that have used Utstein-style reporting. Attention was focused on decreasing the complexity of the existing templates and addressing logistical difficulties in collecting specific core and supplementary (i.e., essential and desirable) data elements recommended by previous Utstein consensus conferences. Inconsistencies in terminology between in-hospital and out-of-hospital Utstein templates were also addressed. The task force produced a reporting tool for essential data that can be used for both quality improvement (registries) and research reports, and that should be applicable to both adults and children. The revised and simplified template includes practical and succinct operational definitions. It is anticipated that this revised template will enable better and more accurate completion of all reports on cardiac arrest and resuscitation attempts. Problems with data definition, collection, linkage, confidentiality, management, and registry implementation are acknowledged and potential solutions offered. Uniform collection and tracking of registry data should enable better continuous quality improvement within every hospital, EMS system, and community.     

Erratum zu: Neugeborenenerstversorgung und Reanimation

Die Anaesthesiologie -     

Erfolgreiche Reanimation nach Thrombolyse und Hypothermiebehandlung

A 45-year-old man suffered a cardiac arrest. Immediately, his 15-year-old daughter started cardiopulmonary resuscitation, and continued until the rescue service arrived. Assuming the existence of a pulmonary embolism, the thromolyticum Alteplase was given, after initially unsuccessful reanimation according to the ERC-Guidelines. After 70 minutes a spontaneous circulation was able to be stimulated. During transport to the intensive-care-unit (ICU), a mild therapeutic hypothermia was initiated. After eleven days in the ICU and a complicated disease course, the patient came out of the coma. Four months later the patient returned to his job without any adverse neurological effects.     

Ethik der Reanimation und Entscheidungen am Lebensende

Notfall + Rettungsmedizin - Diese Ethikleitlinien des Europäischen Rats für Wiederbelebung enthalten evidenzbasierte Empfehlungen für die ethische, routinemäßige Praxis der...     

Erstversorgung und Reanimation von Frühgeborenen

When preterm delivery is imminent prenatal transfer in utero should be undertaken. Whenever there is no neonatologist present at the time of delivery, both gynecologist and anesthesiologist have responsibility in delivery room care of the newborn. Delivery room care of preterm infants requires that special anatomical and physiological features must be taken into account, i.e., the high risk of hypothermia, lack of surfactant, small airways, reduced urge of breathing and poor reserves of energy. Therefore the prevention of heat loss, respiratory stabilization, which can be done without endotracheal intubation in most cases, and to guarantee a sufficient energy supply are particularly important. With adequate delivery room care resuscitation efforts are seldom necessary. This is also true for extremely low birth-weight infants. The international guidelines for neonatal resuscitation (ILCOR) are also applicable to preterm infants. New data show that the probability of survival after cardiopulmonal resuscitation in the delivery room is as high as 70% even in extremely low birth-weight infants. Therefore it is not justified not to treat those patients.     

Erstversorgung, Reanimation und Transport von Neugeborenen

The primary care of neonate poses a particular challenge to those unpracticed in administering first aid. In most cases it suffices to dry off the newborn child after birth, stimulate respiration, and provide warm towels. Expert measures are necessary for a minority of full-term neonates, and for premature infants this need increases in direct relation to the degree of immaturity. The international Liaison Committee on Resuscitation (ILCOR) has developed internationally valid guidelines. These recommendations are not usually based on data from controlled studies but rather on currently recognized experience and teaching theory. Well-trained personnel should be available during every delivery to provide basic care of neonates. For full-scale resuscitation measures, a specialized team is indispensable. The subsequent transport to a clinic represents a strain on the neonate and is associated with special risks. This report presents the ILCOR recommendations and clinical/practical aspects of transporting a newborn child.     

Kardiopulmonale Reanimation und Penicillin als Beispiele des Wiederentdeckens

Die Anaesthesiologie -     

Schweres Thoraxtrauma und pulmonale Fettembolie nach kardiopulmonaler Reanimation

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