Rettungsfachpersonal und Notärzte sollen in der Lage sein, lebensbedrohliche Periarrestrhythmen zu erkennen, einzuschätzen und eine erste lebensrettende Therapie einzuleiten, um einen (erneuten) Kreislaufstillstand abzuwenden.
Dieser Beitrag stellt eine kompakte Zusammenfassung und Bewertung aktueller Studien und Guidelines zur Behandlung der Bradykardie dar.
Abstract
Periarrestrhythms are potentially life-threatening arrhythmias that occur shortly before or after complete cardiac arrest.
It is therefore necessary to detect and treat periarrestrhythms early, also if the cause of the arrhythmia is unknown, which is often the case especially in the prehospital setting. Possible etiologies might be myocardial ischemia, electrolyte disturbances, stimulus formation or transduction disorders and intoxications.
The patient must be checked for hemodynamical stability, following the ABCDE primary survey (A: Airway, B: Breathing, C: Circulation; D: Disability; E: Exposure). Criteria for instability can be summarized as “red flags”:
1. Syncope
2. Signs of Shock
3. Cardiac Failure
4. Signs of myocardial Ischemia
In case of one or more criteria being fulfilled the consecutive algorithm must be followed.
Pharmacological therapy is the first step in life threatening unstable bradycardias.
Due to the guidelines of the European Resuscitation Council (ERC) 500 µg atropine – an unselective muscarinic antagonist – can be administered via the (i.v.)/intraosseous (i.o.) route. This dose can be repeated up to six times every five minutes. Due to the high number of atropine non- or partial responders, other drugs should be chosen soon. Atropine shows no effect in an atrioventricular Block [AV-Block] of higher degree (°II and °III) and in patients after heart transplantation. Adrenaline can stabilize a broad spectrum of bradycardic arrhythmia and provides a potent hemodynamic support.
In case of a failure of the aggressive pharmacological treatment, transthoracic pacing must be applied. For this purpose, standard defibrillator patches are installed – ideally in anterior-posterior position – on the patient’s chest. Pacing frequency and current strength can be chosen. An “80/80 regime” (80 bpm/80 mA) can be a “quick start” in emergency situations.
Further therapeutic failure mandates immediate transport to hospital under conditions of cardiopulmonary resuscitation (CPR).
In summary, a critical situation must be recognized quickly, communicated within the team, and “hit hard and early” with the right therapy.
Schlüsselwörter
Kreislaufstillstand - Früherkennung - Bradykardie - kardiale Arrhythmien - Schrittmachertherapie
Keywords
cardiac arrest - early diagnosis - bradycardia - arrhythmias, cardiac - cardiac pacing, artificial
