Aktuelle Ergebnisse notfallmedizinischer Forschung 2010/2011

Kernaussagen

• Eine Hyperoxie nach erfolgreicher Reanimation verschlechterte im untersuchten Patientenkollektiv das Behandlungsergebnis signifikant. Bei der Hyperoxie besteht ein nahezu linearer Zusammenhang zwischen paO₂ und Letalität. Entsprechend der ERC-Guidelines 2010 ist eine pulsoxymetrisch gemessene Sauerstoffsättigung von 94–96 % nach einer Reanimation ausreichend.

• Die Reanimation mit aktiver Kompression und aktiver Dekompression (AC-DC mit ITV) ist eine Alternative zur konventionellen Reanimation.

• Bei Kindern bleibt die Beatmung wegen der meist respiratorischen Ursachen für Bradykardien/Asystolien ein essenzieller Bestandteil der kardiopulmonalen Reanimation.

• Die Zeitdauer vom Beginn der Symptome beim ST-Streckenhebungs-Infarkt (STEMI) bis zur perkutanen koronaren Intervention (PCI) korreliert mit der Letalität: Je länger die Zeitdauer bis zur Wiedereröffnung des Gefäßes ist, desto größer ist die resultierende Letalität.

• Die Gabe von Ticagrelor senkt das kumulative Risiko für einen Myokardinfarkt/Schlaganfall/Tod im Vergleich zur Gabe von Clopidogrel bei Patienten mit STEMI und beabsichtigter PCI.

• Literatur

• 1 Agrawal S, Brierley J. Optic nerve sheath measurement and raised intracranial pressure in paediatric traumatic brain injury. Eur J Trauma Emerg Surg 2011;
• 2 Aufderheide T, Frascone RJ, Wayne MA et al. Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial. Lancet 2011; 377: 301-311
• 3 Bellomo R, Bailey M, Eastwood GM et al. Arterial hyperoxia and in-hospital mortality after resuscitation from cardiac arrest. Crit Care 2011; 15: R90
• 4 Berens RJ, Cassidy LD, Matchey J et al. Probability of survival based on etiology of cardiopulmonary arrest in pediatric patients. Paediatr Anaesth 2010;
• 5 Bernard SA, Nguyen V, Cameron P et al. Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury. A randomized controlled trial. Ann Surg 2010; 252: 959-965
• 6 Biarent D, Bingham R, Eich C et al. Section 6. Paediatric life support. Resuscitation 2010; 81: 1364-1388
• 7 Böttiger BW, Arntz HR, Chamberlain DA et al. for the TROICA Trial Investigators and the European Resuscitation Council Study Group. Thrombolysis during resuscitation for out-of-hospital cardiac arrest. N Engl J Med 2008; 359: 2651-2662
• 8 Chen L, Hsiao A, Langhan M et al. Use of bedside ultrasound to assess degree of dehydration in children with gastroenteritis. Acad Emerg Med 2010; 17: 1042-1047
• 9 Clifton GL, Valadka A, Zygun D et al. Very early hypothermia induction in patients with severe brain injury (the National Acute Brain Injury Study: Hypothermia II): a randomised trial. Lancet 2011; 10: 131-139
• 10 Cunningham J, Brison RJ, Pickett W. Concussive symptoms in emergency department patients diagnosed with minor head injury. J Emerg Med 2011; 40: 262-266
• 11 Davis DP, Peay J, Sise MJ et al. Prehospital airway and ventilation management: A trauma score and injury severity score-based analysis. J Trauma 2010; 69: 294-301
• 12 Desch S, Eitel I Rahimi et al. Timing of invasive treatment after fibrinolysis in ST elevation myocardial infarction – a meta-analysis of immediate or early routine versus deferred or ischemia-guided randomised controlled trials. Heart 2010;
• 13 Dubourg J, Javouhey E, Geeraerts T et al. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med 2011;
• 14 Emeriaud G, Pettersen G, Ozanne B. Pediatric traumatic brain injury: an update. Curr Opin Anaesthesiol 2011; 24: 307-313
• 15 Fisher JD, Nelson DG, Beyersdorf H et al. Clinical spectrum of shock in the pediatric emergency department. Pediatr Emerg Care 2010; 26: 622-625
• 16 Fraser DD, Close TE, Rose KL et al. for the Canadian Critical Care Translational Biology Group. Severe traumatic brain injury in children elevates glial fibrillary acidic protein in cerebrospinal fluid and serum. Pediatr Crit Care Med 2011; 12: 319-324
• 17 Hallén M, Karlsson M, Carlhed R et al. S-100B in serum and urine after traumatic head injury in children. J Trauma 2010; 69: 284-289
• 18 Halstead ME, Walter KD. Council on Sports Medicine and Fitness. Clinical report – sport-related concussion in children and adolescents. Pediatrics 2010; 126: 597-615
• 19 Hinkelbein J, Böttiger B. The message is clear to save an additional 100 000 lives per year in Europe: ‘harder and faster for cardiopulmonary resuscitation !. Eur J Anaesthesiol 2011; [im Druck]
• 20 Hinkelbein J, Feldmann jr. RE, Kalenka A. Time-dependent alterations of cerebral proteins following short-term normobaric hyperoxia. Mol Cell Biochem 2010; 339: 9-21
• 21 Höhn T, Sasse M. Lebensrettende Maßnahmen bei Neugeborenen und Kindern – neue Leitlinien. Notfallmedizin up2date 2011; 6: 33-51
• 22 Hüpfl M, Selig HF, Nagele P. Chest-compression-only versus standard cardiopulmonary resuscitation: a meta-analysis. Lancet 2010; 376: 1552-1557
• 23 Kilgannon JH, Jones AE, Parrillo JE et al. Relationship between supranormal oxygen tension and outcome after resuscitation from cardiac arrest. Circulation 2011; 123: 2717-2722
• 24 Kilgannon JH, Jones AE, Shapiro NI et al. Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. J Am Med Assoc 2010; 303: 2165-2171
• 25 Levine AC, Shah SP, Umulisa I et al. Ultrasound assessment of severe dehydration in children with diarrhea and vomiting. Acad Emerg Med 2010; 17: 1035-1041
• 26 Maitland K, Kiguli S, Opoka RP et al. the FEAST Trial Group. Mortality after fluid bolus in African children with severe infection. N Engl J Med 2011;
• 27 Mueller DL, Hatab M, Al-Senan R et al. Pediatric radiation exposure during the initial evaluation for blunt trauma. J Trauma 2011; 70: 724-731
• 28 Myburgh JA. Fluid resuscitation in acute illness – time to reappraise the basics. N Engl J Med 2011;
• 29 Nigrovic LE, Schunk JE, Foerster A et al. the Traumatic Brain Injury Group for the Pediatric Emergency Care Applied Research Network. The effect of observation on cranial computed tomography utilization for children after blunt head trauma. Pediatrics 2011; 127: 1067-1073
• 30 Nolan JP, Hazinski MF, Billi JE et al. Part 1: Executive summary: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 2010; 81S: e1-e25
• 31 Nolan JP, Soar J, Zideman DA et al. European Resuscitation Council guidelines for resuscitation 2010 section 1. Executive summary. Resuscitation 2010; 81: 1219-1276
• 32 Ogawa T, Akahane M, Koike S et al. Outcomes of chest compression only CPR versus conventional CPR conducted by lay people in patients with out of hospital cardiopulmonary arrest witnessed by bystanders: nationwide population based observational study. BMJ 2011; 342: c7106
• 33 Ornato JP, Becker LB, Weisfeldt ML et al. Cardiac arrest and resuscitation – An opportunity to align research priorization and public health need. Circulation 2010; 122: 1876-1879
• 34 Ozen LJ, Fernandes MA. Effects of “diagnosis threat” on cognitive and affective functioning long after mild head injury. J Int Neuropsychol Soc 2011; 17: 219-229
• 35 Richmond S, Wyllie J. Section 7. Resuscitation of babies at birth. Resuscitation 2010; 81: 1389-1399
• 36 Steg PG, James S, Harrington RA et al. Ticagrelor versus clopidogrel in patients with ST-elevation acute coronary syndromes intended for reperfusion with primary percutaneous coronary intervention. A Platelet Inhibition and Patient Outcomes (PLATO) Trial subgroup analysis. Circulation 2010; 122: 2131-2141
• 37 Terkelsen CJ, Sørensen JT, Maeng M et al. System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention. J Am Med Assoc 2010; 304: 763-771
• 38 Walson KH, Tang M, Glumac A et al. Normoxic versus hyperoxic resuscitation in pediatric asphyxial cardiac arrest: effects on oxidative stress. Crit Care Med 2011; 39: 335-343
• 39 Westermaier T, Stetter C, Vince GH et al. Prophylactic intravenous magnesium sulfate for treatment of aneurysmal aubarachnoid hemorrhage: a randomized, placebo-controlled, clinical study. Crit Care Med 2010; 38: 1284-1290
• 40 Wong GKC, Poon WS, Chan MTV et al. Intravenous magnesium sulphate for aneurysmal subarachnoid hemorrhage (IMSAH). A randomized, double-blinded, placebo-controlled, multicenter phase III trial. Stroke 2010; 41: 921-926