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Prähospitale Thrombolyse bei akutem Myokardinfarkt

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Notfallbehandlung des akuten Koronarsyndroms

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Zusammenfassung

Im Einsatzspektrum des Notarztes stellen akute Koronarsyndrome einen wesentlichen Anteil. Nach einer Umfrage betrug dieser ca. 20% [1]. Unsere eigene Erfahrung in Berlin liegt sogar noch etwas darüber [2], wobei etwa 30–40% dieser Einsätze einem akuten Herzinfarkt und etwa zwei Drittel einem akuten Koronarsyndrom ohne Infarkt zuzuordnen sind. Der Notarzteinsatz ist bei Patienten mit akutem Koronarsyndrom ohne Zweifel nicht nur berechtigt, sondern auch notwendig; auch die Daten jüngster Erhebungen dokumentieren das hohe Gefährdungspotential der Patienten. Noch immer treten z. B. zwei Drittel aller Todesfälle bei akutem Infarkt in der Prähospitalphase auf [3]. Das Gefährdungspotential der Patienten mit akutem Koronarsyndrom, bei denen ein Infarkt (noch) nicht eingetreten ist, ist höchstens marginal geringer. Weiterhin ist zur differentialdiagnostischen Abgrenzung des Krankheitsbildes und daraus folgender therapeutischer Konsequenzen eine EKG-Registrierung durch den Notarzt notwendig. Schlieβlich ist die Präsenz des Notarztes auch wünschenswert, um unter Berücksichtigung der besonderen Umstände (Alter des Patienten, Infarktlokalisation, klinische Situation) eine Entscheidung über das optimale Zielkrankenhaus (Klinik mit oder ohne Interventionsmöglichkeiten) herbeizuführen. Diese Entscheidung wird der Notarzt u. a. von den logistischen Bedingungen abhängig machen. Die logistischen Bedingungen wiederum werden auch die Entscheidung beeinflussen, bereits prähospital zu einer kausalen Infarkttherapie zu kommen, d. h. die prähospitale Thrombolyse einzuleiten. Wegen des unmittelbaren Zusammenhangs zwischen endgültigem Ausmaβ der Myokardschädigung nach Gefäβverschluss und dem Zeitpunkt einer effektiven Reperfusion wird hierbei der gesamte Zeitrahmen des Infarktverlaufs zu berücksichtigen sein (Abb. 5.4–1). Dieser besteht aus den Komponenten präinfarzieller Angina-pectoris-Perioden, der Zeitdifferenz zwischen dem Auftreten maximaler Symptome (=Infarkteintritt) und dem Eintreffen des Notarztes, der zu erwartenden Transportzeit und den intrahospitalen Verzögerungen im Zielkrankenhaus, einschlieβlich der unvermeidbaren Zeitverluste bis zu einer Akutintervention und schlieβlich der zu erwartenden Zeit bis zur tatsächlich erreichten Reperfusion. Prinzipielles Ziel der Entscheidung muss es dabei bleiben, die Infarktausdehnung so gering wie möglich zu halten, d. h. den Zeitraum zwischen Gefäβverschluss und Reperfusion des Myokards unter Einsatz aller Möglichkeiten so kurz wie möglich zu halten.

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  1. Hans-Richard Arntz
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Editors and Affiliations

  1. Klinikum Benjamin Franklin Med. Klinik II, Kardiopulmologie, Freie Universität Berlin, Hindenburgdamm 30, 12200, Berlin, Germany

    Hans-Richard Arntz

  2. Med. Klinik I, Krankenhaus Düren, Roonstr. 30, 52351, Düren, Germany

    Dietrich C. Gulba

  3. Med. Klinik II, Klinikum Lippe GmbH, Röntgenstr.18, 32756, Detmold, Germany

    Ulrich Tebbe

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Arntz, HR. (2002). Prähospitale Thrombolyse bei akutem Myokardinfarkt. In: Arntz, HR., Gulba, D.C., Tebbe, U. (eds) Notfallbehandlung des akuten Koronarsyndroms. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-56220-4_12

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