Automatische externe Defibrillatoren – Funktionsweise und Einsatz

Zusammenfassung

In Deutschland versterben jährlich über 100 000 Personen am plötzlichen Herztod.

Trotz verschiedener Maßnahmen bleibt jedoch die Prognose des plötzlichen Herztodes schlecht. So beträgt der Anteil an Patienten zwischen 2 und 10 %, die einen plötzlichen Herztod überleben, also aus dem Krankenhaus wieder entlassen werden. Eine Untersuchung an Patienten, bei denen zum Zeitpunkt des einsetzenden plötzlichen Herztodes eine EKG-Dokumentation verfügbar war, zeigt zu 89 % Kammerflimmern oder eine ventrikuläre Tachykardie, also Herzrhythmusstörungen, die mit einem Defibrillator terminiert werden können. Für das Überleben eines Patienten mit diesen Herzrhythmusstörungen ist die Zeit bis zur Defibrillation von herausragender Bedeutung.

Vielfältige Untersuchung haben gezeigt, dass professionelles, nicht-medizinisches Personal (Polizeibeamten, Feuerwehrleute u. a.) aber auch zufällig anwesende Personen in den meisten Fällen den Patienten vor dem Rettungsdienst erreichen. Diese Beobachtung hat zu der Überlegung geführt, Defibrillatoren zu entwickeln, die tachykarde Herzrhythmusstörungen zuverlässig selbstständig erkennen und therapieren können. Diese werden automatische externe Defibrillatoren (AED) bezeichnet. Mit ihrem Einsatz ist es möglich, dass nicht-ärztliches Personal Kammerflimmern behandeln kann und dadurch die Zeit vom Beginn der Herzrhythmusstörung bis zur Terminierung signifikant gesenkt wird. In zahlreichen Studien hat sich gezeigt, dass sowohl First Responder aber auch ungeschulte Laien den AED sicher eingesetzt haben und dadurch eine Senkung der Sterblichkeit am plötzlichen Herztod erreicht werden konnte.

Summary

Every year about 100.000 persons die from sudden cardiac death (SCD) in Germany. Although many efforts have been undertaken, mortality remains high. Only 2 – 10 % of patients with out-off hospital SCD can finally be discharged from hospital after resuscitation. Observational studies show that ventricular fibrillation and ventricular tachycardia are the primary arrhythmias underlying SCD. For both arrhythmias the main determinant for survival is the time between onset and termination by defibrillation. The chance of survival declines by 10 % for every minute of delay. These findings prompted the concept of early defibrillation by first responders.

Many studies have shown that non-medical professionals, like police men, firemen or security officers, often arrive at the patient more early than emergency medical service. Thus, „smart” automated external defibrillators (AEDs), designed to identify VT/VF and prompt the user when to deliver a shock were introduced. These devices allow lay rescuers to terminate ventricular arrhythmias before the arrival of medical professionals. By this approach the time to defibrillation could be reduced and a significant reduction in mortality could be documented in selected situation.

These encouraging results initialled the installation of AED at public places like aircrafts, airports, underground stations and shopping males. Due to the success of this approach doctors are more and more confronted with questions about technical details, reliability and cost effectiveness of these devices. The present review should give an overview about the current studies and guidelines.

Schlüsselwörter

Reanimation - automatischer externer Defibrillator - AED - plötzlicher Herztod

Key words

resusciation - automatic external defibrillator - AED - sudden cardiac death

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