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Antiarrhythmic therapy during cardiac arrest electrical defibrillation and antiarrhythmic drugs

Antiarrhythmische Therapie beim akuten Herz-Kreislaufstillstand

Elektrische Defibrillation und Antiarrhythmika

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Book cover Die Notfalltherapie bei akutem Kreislaufstillstand

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Summary

The success rate of cardiopulmonary resuscitation in patients with cardiac arrest due to ventricular fibrillation is predominantly determined by early de-fibrillation. Biphasic shocks appear superior as compared to standard monophasic shocks. Antiarrhythmic drug treatment only plays a role in cases of refractory ventricular fibrillation despite repetitive defibrillation and application of epinephrine. Amiodarone facilitates the restitution of a stable rhythm and spontaneous circulation; however, no long-term prognostic improvement has been shown. There are no prospective studies showing any benefit for the use of lidocaine during cardiac arrest. Under normal conditions, magnesium does not affect prognosis in patients with cardiac arrest and is only recommended in situations with suspected magnesium deficiency or torsades de pointes.

Zusammenfassung

Entscheidend für den Erfolg einer Reanimation bei Kammerflimmern ist die möglichst frühzeitige Defibrillation. Erste Hinweise sprechen dafür, dass hierbei biphasische Schocks den monophasischen Schocks überlegen sind. Einer zusätzlichen antiarrhythmischen Pharmakotherapie im Rahmen einer Reanimation kommt erst für den Fall von persistierendem Kammerflimmern nach mehreren Schocks und Gabe von Adrenalin eine Bedeutung zu. Amiodaron begünstigt in diesem Fall die Restitution eines stabilen Rhythmus und Wiederherstellung eines Kreislaufes. Eine langfristige Prognoseverbesserung durch Amiodaron ist allerdings nicht nachgewiesen. Für Lidocain wurde bisher kein eindeutiger Nutzen im Rahmen einer Reanimation gezeigt, da prospektive Studien zur Prognose fehlen. Die Gabe von Magnesium hat unter normalen Umständen keinen Einfluss auf die Prognose und wird nur bei vermutetem Magnesiummangel oder Torsade de Pointes Tachykardien empfohlen.

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  1. Medizinische Klinik II (Kardiologie & Pulmologie), Universitätsklinikum Benjamin Franklin Freie Universität Berlin, Hindenburgdamm 30, 12200, Berlin, Germany

    Priv.-Doz. Dr. S. Behrens & M. Zabel

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  1. Klinikum Benjamin Franklin, Medizinische Klinik II, Hindenburgdamm 30, 12200, Berlin, Germany

    H.-R. Arntz

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Behrens, S., Zabel, M. (2002). Antiarrhythmic therapy during cardiac arrest electrical defibrillation and antiarrhythmic drugs. In: Arntz, HR. (eds) Die Notfalltherapie bei akutem Kreislaufstillstand. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-57511-2_6

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