Reanimation bei Kindern[*]

Zusammenfassung

Die kardiopulmonale Reanimation (CPR) bei Kindern ist ein emotionsbehaftetes Ereignis. Laienhelfer ergreifen aus Angst, etwas falsch zu machen, oft nur verzögert oder gar keine lebensrettende Sofortmaßnahmen. Aber auch dem medizinischen Personal fehlt zuweilen die Routine im Umgang mit dem kindlichen Notfallequipment – unkoordiniertes Handeln in der Akutsituation ist die Folge. Dieser Beitrag stellt die Grundlagen der aktuellen ERC-Richtlinien einschließlich Basic und Advanced Life Support dar. Darüber hinaus nennt er Empfehlungen zur Postreanimationstherapie und zur Einbindung der Eltern.

Abstract

Cardiopulmonary resuscitation of a child is a rare, emotionally affective, challenging and potentially frightful event. Current guidelines have been largely simplified to facilitate teaching and retention, to encourage bystander resuscitation, and to improve the quality of resuscitation by healthcare professionals. This article is a practical approach to the current European guidelines (ERC), including basic and advanced life support algorithms, as well as recommendations on the post-resuscitation period and parental presence.

Schlüsselwörter

Reanimation - pädiatrisch - Kinder - Wiederbelebung - Notfall

Key words

resuscitation - paediatric - children - life support - emergency

1 Erstveröffentlichung des Beitrags in der Anästhesiol Intensivmed Notfallmed Schmerzther 2008; 43: 8 – 17
Die vorliegende Fassung ist geringfügig überarbeitet.

Literatur

• 1 The International Liaison Committee on Resuscitation (ILCOR) consensus on science with treatment recommendations for pediatric and neonatal patients: pediatric basic and advanced life support.  Pediatrics. 2006;  117 e955-977
• 2 Biarent D, Bingham R, Richmond S, Maconochie I, Wyllie J, Simpson S, Nunez A R, Zideman D. European Resuscitation Council guidelines for resuscitation 2005. Section 6. Paediatric life support.  Resuscitation. 2005;  67, Suppl 1 S97-133
• 3 Dirks B, Sefrin P. Reanimation 2006 – Empfehlungen der Bundesärztekammer nach den Leitlinien des European Resuscitation Council: Bundesärztekammer. 2006
• 4 Park C, Bahk J H, Ahn W S, Do S H, Lee K H. The laryngeal mask airway in infants and children.  Can J Anaesth. 2001;  48 413-417
• 5 Gausche M, Lewis R J, Stratton S J, Haynes B E, Gunter C S, Goodrich S M, Poore P D, McCollough M D, Henderson D P, Pratt F D, Seidel J S. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial.  JAMA. 2000;  283 783-790
• 6 Newth C J, Rachman B, Patel N, Hammer J. The use of cuffed versus uncuffed endotracheal tubes in pediatric intensive care.  J Pediatr. 2004;  144 333-337
• 7 Khine H H, Corddry D H, Kettrick R G, Martin T M, McCloskey J J, Rose J B, Theroux M C, Zagnoev M. Comparison of cuffed and uncuffed endotracheal tubes in young children during general anesthesia.  Anesthesiology. 1997;  86 627-631; discussion 27A
• 8 Deakers T W, Reynolds G, Stretton M, Newth C J. Cuffed endotracheal tubes in pediatric intensive care.  J Pediatr. 1994;  125 57-62
• 9 Tan A, Schulze A, O'Donnell C P, Davis P G. Air versus oxygen for resuscitation of infants at birth. Cochrane Database Syst Rev 2004 CD002273
• 10 Vento M, Asensi M, Sastre J, Garcia-Sala F, Pallardo F V, Vina J. Resuscitation with room air instead of 100 % oxygen prevents oxidative stress in moderately asphyxiated term neonates.  Pediatrics. 2001;  107 642-647
• 11 Aufderheide T P, Lurie K G. Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation.  Crit Care Med. 2004;  32 S345-351
• 12 Aufderheide T P, Sigurdsson G, Pirrallo R G, Yannopoulos D, McKnite S, Briesen C von, Sparks C W, Conrad C J, Provo T A, Lurie K G. Hyperventilation-induced hypotension during cardiopulmonary resuscitation.  Circulation. 2004;  109 1960-1965
• 13 Bhende M S, LaCovey D C. End-tidal carbon dioxide monitoring in the prehospital setting.  Prehosp Emerg Care. 2001;  5 208-213
• 14 Bhende M S, Thompson A E. Evaluation of an end-tidal CO₂ detector during pediatric cardiopulmonary resuscitation.  Pediatrics. 1995;  95 395-399
• 15 Rocha e Silva M. Hypertonic saline resuscitation.  Medicina (B Aires). 1998;  58 393-402
• 16 Cherian L, Goodman J C, Robertson C S. Hyperglycemia increases brain injury caused by secondary ischemia after cortical impact injury in rats.  Crit Care Med. 1997;  25 1378-1383
• 17 Mann K, Berg R A, Nadkarni V. Beneficial effects of vasopressin in prolonged pediatric cardiac arrest: a case series.  Resuscitation. 2002;  52 149-156
• 18 Voelckel W G, Lurie K G, McKnite S, Zielinski T, Lindstrom P, Peterson C, Krismer A C, Lindner K H, Wenzel V. Comparison of epinephrine and vasopressin in a pediatric porcine model of asphyxial cardiac arrest.  Crit Care Med. 2000;  28 3777-3783
• 19 Dorian P, Cass D, Schwartz B, Cooper R, Gelaznikas R, Barr A. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation.  N Engl J Med. 2002;  346 884-890
• 20 Stueven H A, Thompson B, Aprahamian C, Tonsfeldt D J, Kastenson E H. The effectiveness of calcium chloride in refractory electromechanical dissociation.  Ann Emerg Med. 1985;  14 626-629
• 21 Stueven H A, Thompson B, Aprahamian C, Tonsfeldt D J, Kastenson E H. Lack of effectiveness of calcium chloride in refractory asystole.  Ann Emerg Med. 1985;  14 630-632
• 22 Tzivoni D, Banai S, Schuger C, Benhorin J, Keren A, Gottlieb S, Stern S. Treatment of torsade de pointes with magnesium sulfate.  Circulation. 1988;  77 392-397
• 23 Losek J D. Hypoglycemia and the ABC'S (sugar) of pediatric resuscitation.  Ann Emerg Med. 2000;  35 43-46
• 24 Srinivasan V, Spinella P C, Drott H R, Roth C L, Helfaer M A, Nadkarni V. Association of timing, duration, and intensity of hyperglycemia with intensive care unit mortality in critically ill children.  Pediatr Crit Care Med. 2004;  5 329-336
• 25 Lokesh L, Kumar P, Murki S, Narang A. A randomized controlled trial of sodium bicarbonate in neonatal resuscitation-effect on immediate outcome.  Resuscitation. 2004;  60 219-223
• 26 Schneider T, Martens P R, Paschen H, Kuisma M, Wolcke B, Gliner B E, Russell J K, Weaver W D, Bossaert L, Chamberlain D. Multicenter, randomized, controlled trial of 150-J biphasic shocks compared with 200- to 360-J monophasic shocks in the resuscitation of out-of-hospital cardiac arrest victims. Optimized Response to Cardiac Arrest (ORCA) Investigators.  Circulation. 2000;  102 1780-1787
• 27 Rossano J W, Quan L, Kenney M A, Rea T D, Atkins D L. Energy doses for treatment of out-of-hospital pediatric ventricular fibrillation.  Resuscitation. 2006;  70 80-89
• 28 Clark C B, Zhang Y, Davies L R, Karlsson G, Kerber R E. Pediatric transthoracic defibrillation: biphasic versus monophasic waveforms in an experimental model.  Resuscitation. 2001;  51 159-163
• 29 Berg R A, Samson R A, Berg M D, Chapman F W, Hilwig R W, Banville I, Walker R G, Nova R C, Anavy N, Kern K B. Better outcome after pediatric defibrillation dosage than adult dosage in a swine model of pediatric ventricular fibrillation.  J Am Coll Cardiol. 2005;  45 786-789
• 30 Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.  N Engl J Med. 2002;  346 549-556
• 31 Bernard S A, Gray T W, Buist M D, Jones B M, Silvester W, Gutteridge G, Smith K. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia.  N Engl J Med. 2002;  346 557-563
• 32 Compagnoni G, Pogliani L, Lista G, Castoldi F, Fontana P, Mosca F. Hypothermia reduces neurological damage in asphyxiated newborn infants.  Biol Neonate. 2002;  82 222-227
• 33 Zeiner A, Holzer M, Sterz F, Schorkhuber W, Eisenburger P, Havel C, Kliegel A, Laggner A N. Hyperthermia after cardiac arrest is associated with an unfavorable neurologic outcome.  Arch Intern Med. 2001;  161 2007-2012
• 34 Robinson S M, Mackenzie-Ross S, Campbell H ewson, Egleston C V, Prevost A T. Psychological effect of witnessed resuscitation on bereaved relatives.  Lancet. 1998;  352 614-617
• 35 Jöhr M. Kleine Kinder – große Probleme.  Anästh Intensivmed. 2005;  46 358-372
• 36 Jöhr M. Die Wahl der Tubusgröße beim Kind.  Anästhesist. 2002;  51 326-327
• 37 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) an emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric basic life support.  Pediatrics. 2006;  117 e989-1004

1 Erstveröffentlichung des Beitrags in der Anästhesiol Intensivmed Notfallmed Schmerzther 2008; 43: 8 – 17
Die vorliegende Fassung ist geringfügig überarbeitet.