[Emergency medicine -- new concepts and therapies improve outcome from cardiac arrest].
According to scientific articles focusing on emergency medicine published in international journals in the past few months, early defibrillation by lay persons, thrombolysis during cardiopulmonary resuscitation (CPR) and treatment with mild therapeutic hypothermia have been identified as relevant, new and clinically important treatment options to improve outcome following cardiac arrest. Early defibrillation using automated external defibrillators by lay persons reduces the time interval between collapse and first attempts at defibrillation and thus improves outcome after prehospital cardiac arrest. Thrombolysis during CPR -- for which the results regarding safety and efficacy are available from nonrandomized trials -- can also be safely performed in case of pulseless electrical activity. Thrombolysis during cardiopulmonary resuscitation has, however, no significant effect in this subgroup of patients with pulseless electrical activity in whom outcome is poor if the drug is administered at the end of conventional CPR procedures. Mild therapeutic hypothermia, i. e., cooling of cardiac arrest victims to 32-34 degrees C central body temperature for 12-24 h following out-of-hospital cardiac arrest, markedly improves survival rate and neurological outcome. Since this has now been clearly documented in two randomized clinical trials, it can be assumed that this kind of intervention will be recommended and translated into clinical practice soon. In conclusion, new and clinically relevant methods to improve outcome following cardiac arrest are available and can now be widely used clinically.
Böttiger
B W
BW
Klinik für Anaesthesiologie, Universitätsklinikum Heidelberg. bernd_boettiger@med.uni-heidelberg.de
Groeben
H
H
Heine
J
J
D016887:Cardiopulmonary Resuscitation; D003128:Coma / Q000628:therapy; D004554:Electric Countershock; D004632:Emergency Medical Services / Q000639:trends*; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced