Abstract
In patients with out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) following cardiopulmonary resuscitation (CPR), the prognosis is influenced by various factors. In the prehospital setting, the duration of ischemia from the time of onset of cardiac arrest to the beginning of effective resuscitation measures is by far the most critical and determining factor for outcome. This interval can be shortened by an increase in the rate of lay CPR measures. With respect to intrahospital follow-up care, anumber of structural factors have arelevant influence on prognosis. According to the literature, case volume, size of the hospital and the number of post-OHCA patients treated per year also have a large influence on the further prognosis. The crucial factor here is the availability and permanent readiness of acatheterization laboratory with the possibility of an immediate coronary intervention. In OHCA patients with ST-segment elevation myocardial infarction (STEMI), the time passed until the reopening of the occluded infarcted vessel is of paramount importance for survival. The 24/7 around the clock availability of acatheterization laboratory is therefore one of the indispensable prerequisites for acardiac arrest center (CAC). In addition, anumber of technical, structural, and organizational arrangements must be implemented in the CAC clinics in order to fulfil the requirements for such acenter. The certification of CACs is currently being implemented by the German Resuscitation Council (GRC) and the German Society of Cardiology (DGK). As an important aim the GRC and the medical societies involved are hoping to avoid misallocation of post-OHCA patients to the nearest hospital, which may not be asuitable center for the treatment of these patients. Future studies will show whether CACs can indeed comprehensively improve the prognosis of OHCA patients following successful prehospital resuscitation.
Highlights
the prognosis is influenced by various factors
This interval can be shortened by an increase in the rate
a number of structural factors have a relevant influence on prognosis
Summary
In Deutschland trifft der professionelle Rettungsdienst in der Regel jedoch erst später am Notfallort ein, und es wäre eine Illusion, anzunehmen, dass innerhalb von 3–5 min bei einem relevanten Anteil der Patienten mit prähospitalem Kreislaufstillstand („out-of-hospital cardiac arrest“, OHCA) bereits professionelle Hilfe zur Verfügung steht. Hier können allerdings Laien richtig helfen, und nach Literaturangaben kann bei OHCA die Überlebensrate durch Laienreanimation verdoppelt werden [5, 6]. Ein effektives Mittel zur Steigerung der Quote der Laienreanimation ist die Telefonreanimation, d. In einigen europäischen Ländern konnte durch die Integration einer Reanimationsschulung in den Schulunterricht die Laienreanimationsquote erheblich gesteigert werden [11, 12]. Auch in Deutschland wurde inzwischen in einigen Bundesländern ein systematisches Reanimationstraining als Unterrichtsfach für Schüler eingeführt
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