Aktuelle Intensivtherapie der aneurysmatischen Subarachnoidalblutung

Kernaussagen

• Die Konsensusempfehlung der NCS liefert konkrete Handlungsvorschläge zur intensivmedizinischen Therapie der Subarachnoidalblutung.

• Ziele sind eine schnellstmögliche Aneurysmaversorgung und die Verhinderung sekundärer Ischämien.

• Zur Reduktion des Nachblutungsrisikos kann man bis zur Aneurysmaversorgung eine kurzzeitige antifibrinolytische Therapie mit Tranexamsäure erwägen.

• Wichtig ist die Erkennung, Verhütung und Behandlung verzögerter zerebraler Ischämien.

• Zur primären Therapie gehört eine Verbesserung der Hirndurchblutung durch eine induzierte Hypertonie.

• Entgegen der jahrzehntelangen Praxis sind eine Hypervolämie und Hämodilution nicht mehr zu empfehlen.

• Moderne endovaskuläre Verfahren sind in spezialisierten Zentren mit hinreichender Sicherheit als Notfalltherapie einsetzbar.

• Literatur

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