Mechanische Reanimationshilfen: Neue Entwicklungen und erste Ergebnisse

Abstract

Cardiopulmonary resuscitation (CPR) is associated with a poor prognosis. Recent data suggest that chest compressions, even when performed by qualified persons, are often suboptimal. In clinical and laboratory studies, continuous chest compression can improve coronary perfusion pressures as a prerequisite for the restoration of circulation as compared with conventional CPR with chest compressions and ventilations. Results from animal studies clearly show that continuous chest compression performed by devices can improve the outcome after CPR compared to manual compressions. Currently, two devices for CPR are commercially available, LUCAS and AutoPulse. Few clinical studies have been performed with these devices, showing a trend towards a better restoration of spontaneous circulation. The effect of device-assisted CPR on long-term survival or neurologic status has not been addressed yet. Data are inconsistent, and the broad use of these devices currently can not be recommended on the basis of evidence. They may, however, be useful in selected patients, especially when the basic condition leading to CPR is likely to be reversed during prolonged measures, such as hyperkalemia or pulmonary embolism. The article summarizes currently available clinical data and the author’s experiences with the devices.

Kernaussagen

Trotz Modifikationen der Reanimationsalgorithmen in den letzten Jahren sind die Langzeitergebnisse der kardiopulmonalen Reanimation immer noch unbefriedigend. In einer Reihe von Studien konnte gezeigt werden, dass die manuelle Thoraxkompression, auch wenn sie von erfahrenem Personal durchgeführt wird, nicht so effektiv ist, wie es die Leitlinien erfordern.

Mechanische Reanimationshilfen zur Thoraxkompression stellen theoretisch - aufgrund der konstant applizierten Kompression ohne Notwendigkeit, die einer Unterbrechung für Maßnahmen wie z. B. eine Defibrillation - eine sinnvolle Ergänzung der Reanimation dar. Im Tierversuch sind sie der manuellen Reanimation eindeutig überlegen. Klinische Daten sind jedoch, am ehesten aufgrund sehr heterogener Patientenkollektive in den wenigen durchgeführten Studien, uneinheitlich.

Der globale, unkritische Einsatz der aktuell verfügbaren mechanischen Reanimationshilfen kann nicht generell empfohlen werden. Ein differenzierter Einsatz bei klarer Indikationsstellung und idealerweise eine wissenschaftliche Aufarbeitung der behandelten Fälle scheint jedoch ein sinnvoller Weg, um den definitiven Nutzen dieser Methode in der Zukunft klären zu können.

Literatur

• 1 Cooper J A, Cooper J D, Cooper J M. Cardiopulmonary Resuscitation: History, Current Practice, and Future Direction.  Circulation. 2006;  114 2839-2849
• 2 Weisfeldt M L, Becker L B. Resuscitation after cardiac arrest: a 3-phase time-sensitive model.  JAMA. 2002;  288 3035-3038
• 3 Paradis N A, Martin G B, Rivers E P. et al . Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation.  JAMA. 1990;  263 1106-1113
• 4 Ewy G A. Cardiocerebral Resuscitation: The New Cardiopulmonary Resuscitation.  Circulation. 2005;  111 2134-2142
• 5 SOS-KANTO study group . Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study.  Lancet. 2007;  369 920-926
• 6 Abella B S, Sandbo N, Vassilatos P. et al . Chest Compression Rates During Cardiopulmonary Resuscitation Are Suboptimal: A Prospective Study During In-Hospital Cardiac Arrest.  Circulation. 2005;  111 428-434
• 7 Ochoa F J, Ramalle-Gomara E, Lisa V, Saralegui I. The effect of rescuer fatigue on the quality of chest compressions.  Resuscitation. 1998;  37 149-152
• 8 Huseyin T S, Matthews A J, Wills P, O'Neill V M. Improving the effectiveness of continuous closed chest compressions: an exploratory study.  Resuscitation. 2002;  54 57-62
• 9 Wik L. Automatic and manual mechanical external chest compression devices for cardiopulmonary resuscitation.  Resuscitation. 2000;  47 7-25
• 10 Halperin H R, Tsitlik J E, Gelfand M. et al . A Preliminary Study of Cardiopulmonary Resuscitation by Circumferential Compression of the Chest with Use of a Pneumatic Vest.  N Engl J Med. 1993;  329 762-768
• 11 Arntz H R, Agrawal R, Richter H. et al . Phased Chest and Abdominal Compression-Decompression Versus Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest.  Circulation. 2001;  104 768-772
• 12 Lurie K G, LIndo C, Chin J. CPR: the P stands for plumber's helper.  JAMA. 1990;  264 1661
• 13 Mauer D. Alternative Verfahren der mechanischen kardiopulmonalen Reanimation.  Notfall Rettungsmed. 1999;  2 196-206
• 14 Steen S, Liao Q, Pierre L, Paskevicius A, Sjoberg T. Continuous intratracheal insufflation of oxygen improves the efficacy of mechanical chest compression-active decompression CPR.  Resuscitation. 2004;  62 219-227
• 15 Lafuente-Lafuente C, Melero-Bascones M. Active chest compression-decompression for cardiopulmonary resuscitation.  Cochrane Database of Systematic Reviews. 2004;  DOI: 10.1002/14 651 858
• 16 Hallstrom A, Rea T D, Sayre M R. et al . Manual chest compression vs use of an automated chest compression device during resuscitation following out-of-hospital cardiac arrest.  JAMA. 2006;  295 2620-2628
• 17 Ong M EH, Ornato J P, Edwards D P. et al . Use of an Automated, Load-Distributing Band Chest Compression Device for Out-of-Hospital Cardiac Arrest Resuscitation.  JAMA. 2006;  295 2629-2637
• 18 Casner M, Andersen D, Isaacs S M. The impact of a new CPR assist device on rate of return of spontaneous circulation in out-of-hospital cardiac arrest.  Prehospital Emergency Care. 2005;  9 61-67
• 19 Steen S, Sjoberg T, Olsson P, Young M. Treatment of out-of-hospital cardiac arrest with LUCAS, a new device for automatic mechanical compression and active decompression resuscitation.  Resuscitation. 2005;  67 25-30
• 20 Maule Y. L'assistance cardiaque externe: nouvelle approche dans la RCP.  Urgences&Accueil. 2007;  7 4-7
• 21 Axelsson C, Nestin J, Svensson L, Axelsson A B, Herlitz J. Clinical consequences of the introduction of mechanical chest compression in the EMS system for treatment of out-of-hospital cardiac arrest - A pilot study.  Resuscitation. 2006;  71 47-55
• 22 American Heart association . Guidelines for cardiopulmonary resuscitation Part 6: CPR Techniques and Devices.  Circulation. 2005;  112 (suppl) IV-47
• 23 Larsen A I, Hjornevik A S, Ellingsen C L, Nilsen D WT. Cardiac arrest with continuous mechanical chest compression during percutaneous coronary intervention: A report on the use of the LUCAS device.  Resuscitation. 2007;  75 454-459