Download PDF
NOTARZT 2018; 34(02): 80-84
DOI: 10.1055/s-0043-121133
Kasuistik
Georg Thieme Verlag KG Stuttgart · New York

Reanimation eines Säuglings – ST-Hebungsinfarkt und Kammerflimmern, nicht nur ein Phänomen des Erwachsenen

Resuscitation of an Infant with Ventricular Fibrillation and ST-Elevation Myocardial Infarction
Tobias Hübner
1   Abteilung für Innere Medizin und Gastroenterologie, Klinik Hallerwiese, Nürnberg
,
Patrick Kellner
2   Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein – Campus Lübeck,
,
Michael Schroth
3   Abteilung für Neonatologie und Pädiatrische Intensivstation, Cnopfʼsche Kinderklinik, Nürnberg
› Author Affiliations
Further Information

Publication History

Publication Date:
11 January 2018 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Der plötzliche Herztod ist mit etwa 80 000 bis 100 000 Fällen pro Jahr eine der häufigsten Todesursachen in Deutschland (Reanimationsregister). Dabei sind Reanimationsereignisse in der Erwachsenenmedizin deutlich häufiger als in der Kinderheilkunde. Wir berichten über einen 7 Monate alten männlichen Säugling, der leblos in der elterlichen Wohnung vorgefunden wurde. Der Primärrhythmus war Kammerflimmern und wurde durch 2-malige biphasische elektrische Schockabgabe erfolgreich terminiert. Nach ROSC (return of spontaneous circulation) wurde der Säugling auf eine pädiatrische Intensivstation verbracht. Im angefertigten 12-Kanal-EKG sah man das Bild eines akuten ST-Hebungsinfarkts (STEMI) der Vorderwand, sodass eine invasive Koronardiagnostik erfolgte. Dort zeigte sich ein Komplettverschluss des R. interventricularis anterior (RIVA) sowie ausgeprägte Koronaraneurysmata der anderen Herzkranzgefäße auf dem Boden eines Kawasaki-Syndroms.

Abstract

With about 80 000 to 100 000 reported cases per year, sudden cardiac death is one of the most frequent causes of death in Germany. In this context, cardio-pulmonary resuscitations are much more common in adults compared to pediatric populations. We report a 7-month-old infant who was found lifeless at home. Primary ECG showed ventricular fibrillation, which was terminated by biphasic defibrillation. After return of spontaneous circulation (ROSC) the infant was transferred to a pediatric intensive care unit. A 12-lead ECG revealed an ST-elevated anterior myocardial infarction; immediate cardiac catheter examination showed a total occlusion of the anterior ramus interventricularis (RIVA). Additionally, pronounced coronary aneurysms based on Kawasaki disease were found.

Schlüsselwörter

präklinischer Herzkreislaufstillstand - Reanimation - Defibrillation - Kawasaki-Syndrom - Säugling

Key words

resuscitation - pediatrics - defibrillation - out-of-hospital cardiac arrest - Kawasaki disease
 

  • Literatur

  • 1 Atkins DL, Everson-Stewart S, Sears GK. et al. Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. Circulation 2009; 119: 1484-1491
    CrossrefPubMedGoogle Scholar
  • 2 Kato H, Ichinose E, Kawasaki T. Myocardial infarction in Kawasaki disease: clinical analyses in 195 cases. J Pediatr 1986; 108: 923-927
    CrossrefPubMedGoogle Scholar
  • 3 Javadzadegan H, Mehdizadeh Baghbani J, Farhang S. Acute myocardial infarction as the first manifestation of the incomplete Kawasaki disease in a young male. Cardiol Young 2009; 19: 635-637
    CrossrefPubMedGoogle Scholar
  • 4 Kawasaki T. [Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children]. Arerugi 1967; 16: 178-222
    PubMedGoogle Scholar
  • 5 Newburger JW, Takahashi M, Gerber MA. et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2004; 110: 2747-2771
    CrossrefPubMedGoogle Scholar
  • 6 Maconochie IK, Bingham R, Eich C. et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 6. Paediatric life support. Resuscitation 2015; 95: 223-248
    CrossrefPubMedGoogle Scholar
  • 7 Rechner JA, Loach VJ, Ali MT. et al. A comparison of the laryngeal mask airway with facemask and oropharyngeal airway for manual ventilation by critical care nurses in children. Anaesthesia 2007; 62: 790-795
    CrossrefPubMedGoogle Scholar
  • 8 Park C, Bahk JH, Ahn WS. et al. The laryngeal mask airway in infants and children. Can J Anaesth 2001; 48: 413-417
    CrossrefPubMedGoogle Scholar
  • 9 Hoffmann F, Keil J, Urban B. et al. Atemwegsmanagement mit supraglottischen Atemwegshilfen in der Kindernotfallmedizin – Larynxmaske ist State-of-the-art. Anästh Intensivmed 2016; 57: 377-386
    PubMedGoogle Scholar
  • 10 Wirtz S, Eich C, Becke K. et al. [Use of cognitive aids in pediatric emergency care: Interdisciplinary consensus statement]. Anaesthesist 2017; 66: 340-346
    CrossrefPubMedGoogle Scholar
  • 11 Kaufmann J, Roth B, Engelhardt T. et al. Development and prospective federal state-wide evaluation of a device for height-based dose recommendations in prehospital pediatric emergencies: a simple tool to prevent most severe drug errors. Prehosp Emerg Care 2016; DOI: 10.1080/10903127.2016.1248257.
    PubMedGoogle Scholar
  • 12 Khine HH, Corddry DH, Kettrick RG. et al. Comparison of cuffed and uncuffed endotracheal tubes in young children during general anesthesia. Anesthesiology 1997; 86: 627-631
    CrossrefPubMedGoogle Scholar
  • 13 Helm M, Gries A, Fischer S. et al. [Invasive techniques in emergency medicine. III. Intraosseous punction – an alternative vascular access in paediatric emergencies]. Anaesthesist 2005; 54: 49-56
    CrossrefPubMedGoogle Scholar
  • 14 Meyburg J, Bernhard M, Hoffmann GF. et al. Principles of pediatric emergency care. Dtsch Arztebl Int 2009; 106: 739-747
    Google Scholar
  • 15 Yamamoto T, Schindler E. Notfälle im Rettungsdienst und in der Klinik: Gefäßzugänge bei Kindern. Anasthesiol Intensivmed Notfallmed Schmerzther 2017; 52: 55-64
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Buck ML, Wiggins BS, Sesler JM. Intraosseous drug administration in children and adults during cardiopulmonary resuscitation. Ann Pharmacother 2007; 41: 1679-1686
    CrossrefPubMedGoogle Scholar
  • 17 Schroth M, Hossfeld B. Leserbrief zum Beitrag: M. Hufnagel „Intraossärer Zugang – Komplikation kann zur Amputation führen“. Notarzt 2016; 32: 205
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Hickey RW, Cohen DM, Strausbaugh S. et al. Pediatric patients requiring CPR in the prehospital setting. Ann Emerg Med 1995; 25: 495-501
    CrossrefPubMedGoogle Scholar
  • 19 Rossano JW, Quan L, Kenney MA. et al. Energy doses for treatment of out-of-hospital pediatric ventricular fibrillation. Resuscitation 2006; 70: 80-89
    CrossrefPubMedGoogle Scholar
  • 20 Mogayzel C, Quan L, Graves JR. et al. Out-of-hospital ventricular fibrillation in children and adolescents: causes and outcomes. Ann Emerg Med 1995; 25: 484-491
    CrossrefPubMedGoogle Scholar
  • 21 Young KD, Seidel JS. Pediatric cardiopulmonary resuscitation: a collective review. Ann Emerg Med 1999; 33: 195-205
    CrossrefPubMedGoogle Scholar
  • 22 Gurnett CA, Atkins DL. Successful use of a biphasic waveform automated external defibrillator in a high-risk child. Am J Cardiol 2000; 86: 1051-1053
    CrossrefPubMedGoogle Scholar
  • 23 Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002; 346: 549-556
    CrossrefPubMedGoogle Scholar
  • 24 Moler FW, Silverstein FS, Holubkov R. et al. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. N Engl J Med 2015; 372: 1898-1908
    CrossrefPubMedGoogle Scholar