Postreanimationserkrankung und Postreanimationstherapie

Kernaussagen

Die therapeutischen Prinzipien in der Postreanimationsphase sollten zielgerichtet auf die Minimierung und Prophylaxe von Folgeschäden abheben. Patienten ohne ersichtlichen Reanimationsgrund sollten einer invasive Koronardiagnostik zugeführt werden. Zur weiteren Abklärung der Reanimationsursache sind eine echokardiografische Untersuchung sowie eine weitere laborchemische und erweiterte radiologische Diagnostik durchzuführen. So früh wie möglich sollte man eine therapeutische Hypothermie mit einer Zieltemperatur von 33 °C für insgesamt 12 – 24 h einleiten.

Während der Postreanimationstherapie sind die engmaschige Glukosekontrolle mit einem Ziel von 6 – 8,25 mmol/l (110 – 150 mg/dl), eine ausreichende Sedierung während der therapeutischen Hypothermie sowie eine bestmögliche zerebrale Anfallsprophylaxe zur idealen Neuroprotektion erforderlich. Als Oxygenierungsziel sollte eine periphere Gewebesättigung von 94 – 96 % mit einem paO₂ von über 65 mmHg angestrebt werden. Zur Aufrechterhaltung des zerebralen Perfusionsdrucks ist ein mittlerer arterieller Blutdruck von über 80 – 90 mmHg erforderlich. Zur Optimierung des venösen Abflusses sollte eine 30°-Oberkörperhochlagerung durchgeführt werden.

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