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Vorgehen nach erfolgreicher Reanimation – kühlen oder nicht mehr kühlen?

Procedure after successful cardiopulmonary resuscitation—Cooling or no more cooling?

  • Schwerpunkt: Neue Entwicklungen in der internistischen Intensivmedizin
  • Published:
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Zusammenfassung

In Europa erleiden jedes Jahr etwa 84 von 100.000 Einwohner:innen einen außerklinischen Herz-Kreislauf-Stillstand (HKS). Die Sterblichkeit ist hoch und wird insbesondere durch den vorherrschenden kardiogenen Schockzustand und die hypoxisch-ischämische Enzephalopathie bestimmt. Als einzige neuroprotektive Intervention wurde für zwei Jahrzehnte die milde therapeutische Hypothermie in der Postreanimationstherapie empfohlen. Jedoch konnten kürzlich publizierte Studien keine Verbesserung des neurologischen Ergebnisses mit milder therapeutischer Hypothermie im Vergleich zur Normothermie in der Postreanimationstherapie nachweisen. Laut den 2022 publizierten Leitlinien des European Resuscitation Council (ERC) und der European Society of Intensive Care Medicine (ESICM) sollen bewusstlose Erwachsene nach HKS mit einem Temperaturmanagement behandelt und Fieber aktiv vermieden werden. Allerdings bleiben viele Fragen hinsichtlich der optimalen Zieltemperatur, der Kühlmethoden und der optimalen Dauer weiterhin offen. Trotz dieser noch offenen Punkte sollte bei allen Patient:innen in der Postreanimationsphase weiterhin eine strukturierte und qualitativ hochwertige Postreanimationstherapie erfolgen, die ein gezieltes Temperaturmanagement einschließt, unabhängig von der gewählten Zieltemperatur. Insbesondere die Fiebervermeidung bleibt ein wichtiger Bestandteil der Postreanimationstherapie.

Abstract

Approximately 84 out of 100,000 inhabitants in Europe suffer from an out of hospital cardiac arrest (OHCA) each year. The mortality after cardiac arrest (CA) is high and is particularly determined by the predominant cardiogenic shock condition and hypoxic ischemic encephalopathy. For almost two decades hypothermic temperature control was the only neuroprotective intervention recommended in guidelines for postresuscitation care; however, recently published studies failed to demonstrate any improvement in the neurological outcome with hypothermia in comparison to strict normothermia in postresuscitation treatment. According to the European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) guidelines published in 2022, unconscious adults after CA should be treated with temperature management and avoidance of fever; however, many questions remain open regarding the optimal target temperature, the cooling methods and the optimal duration. Despite these currently unanswered questions, a structured and high-quality postresuscitation care that includes a targeted temperature management should continue to be provided for all patients in the postresuscitation phase, independent of the selected target temperature. Furthermore, fever avoidance remains an important component of postresuscitation care.

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Authors and Affiliations

  1. Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    Kevin Roedl &  Stefan Kluge

  2. Interdisziplinäre Notaufnahme, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Deutschland

    Sebastian Wolfrum

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Correspondence to Kevin Roedl.

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S. Wolfrum: Vortragstätigkeit: Zoll, B & D. S. Kluge: Vortragstätigkeit: Zoll. K. Roedl gibt an, dass kein Interessenkonflikt besteht.

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Roedl, K., Wolfrum, S. & Kluge, S. Vorgehen nach erfolgreicher Reanimation – kühlen oder nicht mehr kühlen?. Innere Medizin 64, 932–938 (2023). https://doi.org/10.1007/s00108-023-01582-2

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