Reanimation durch Einsatz eines AED nach Verkehrsunfall^[*]

Zusammenfassung

Nach einem vergleichsweise trivialen Verkehrsunfall stieg der 65-jährige Unfallfahrer aus dem Fahrzeug und kollabierte kurz darauf. Zufällig vor Ort befindliche Polizeibeamte leiteten unverzüglich eine kardiopulmonale Reanimation ein. Ein Passant entnahm aus einem benachbarten Firmenfoyer den dort stationierten, frei zugänglichen Defibrillator. Nach Anbringen der Elektroden und Analyse des Defibrillators wurde ein Schock (200 Joule, biphasisch) ausgelöst. Das zugrunde liegende Kammerflimmern wurde dadurch terminiert. In der Klinik ergab die Akutherzkatheteruntersuchung eine hochgradige, filiforme Stenose der proximalen rechten Koronararterie, die durch einen Stent versorgt wurde. Aufgrund der optimalen Basismaßnahmen, der sofortigen notfallmedizinischen Versorgung und der erfolgreichen Revaskularisation war der Verlauf sehr günstig; der Patient konnte ohne jegliche neurologische Defizite nach Hause entlassen werden. Der Fall zeigt beispielhaft, dass automatisierte externe Defibrillatoren im Rahmen der kardiopulmonalen Reanimation auch von Laien problemlos und sicher angewandt werden können.

Abstract

A 65-year-old man collapsed after he stepped out of his car after a traffic accident. Fortunately, two police officers on a routine patrol in the area were quickly on the scene and started cardiopulmonary resuscitation. A passerby noticed that the patient was in distress and that an automatic defibrillator was nearby. He attached the electrodes of the defibrillator to the chest of the patient in accordance with instructions on the defibrillator and terminated the ventricular fibrillation (200 joule, biphasic). Emergency cardiac catheterization revealed a subtotal stenosis proximally in the right coronary artery, which was successfully treated with a stent. Based on the ideal basic life support, the immediate care by emergency mobile system and coronary angioplasty with successful revascularisation the patient could be released without any neurological deficit. This case illustrates that laypersons can use automatic external defibrillator in case of cardiac resuscitation sufficiently and quickly.

Schlüsselwörter

automatischer externer Defibrillator - kardiopulmonale Reanimation - Frühdefibrillation

Keywords

external defibrillator - cardiopulmonary resuscitation - early defibrillation

• Literatur

• 1 Nolan JP, Soar J, Zideman DA et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation 2010; 81: 1219-1276
• 2 Bunch TJ, White RD, Gersh BJ et al. Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 2003; 348: 2626-2633
• 3 Eames P, Larsen PD, Galletly DC. Comparison of ease of use of three automated external defibrillators by untrained lay people. Resuscitation 2003; 58: 25-30
• 4 Weisfeldt ML, Sitlani CM, Ornato JP et al. Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million. J Am Coll Cardiol 2010; 55: 1713-1720
• 5 Caffrey SL, Willoughby PJ, Pepe PE et al. Public use of automated external defibrillators. N Engl J Med 2002; 347: 1242-1247
• 6 Mosesso Jr VN, Davis EA, Auble TE et al. Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac arrest. Ann Emerg Med 1998; 32: 200-207
• 7 Hansen CM, Wissenberg M, Weeke P et al. Automated external defibrillators inaccessible to more than half of nearby cardiac arrests in public locations during evening, nighttime, and weekends. Circulation 2013; 128: 2224-2231
• 8 Herlitz J, Eek M, Engdahl J et al. Factors at resuscitation and outcome among patients suffering from out of hospital cardiac arrest in relation to age. Resuscitation 2003; 58: 309-317
• 9 Levy MJ, Seaman KG, Millin MG et al. A poor association between out-of-hospital cardiac arrest location and public automated external defibrillator placement. Prehosp Disaster Med 2013; 28: 342-347
• 10 Chan TC, Li H, Lebovic G et al. Identifying locations for public access defibrillators using mathematical optimization. Circulation 2013; 127: 1801-1809
• 11 Larsen MP, Eisenberg MS, Cummins RO et al. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med 1993; 22: 1652-1658
• 12 Eilevstjonn J, Kramer-Johansen J, Eftestol T et al. Reducing no flow times during automated external defibrillation. Resuscitation 2005; 67: 95-101
• 13 Li Y, Bisera J, Weil MH et al. An algorithm used for ventricular fibrillation detection without interrupting chest compression. IEEE Trans Biomed Eng 2012; 59: 78-86