Präklinische Point-of-Care-Diagnostik bei Reanimation: Wie relevant sind erste Laborwerte für den Notarzt?

Hintergrund: Metabolische oder Elektrolytentgleisungen können zu einem Kreislaufstillstand führen, diesen aufrechterhalten oder den Patienten danach erneut destabilisieren. Die Leitlinien fordern seit jeher eine frühzeitige Detektion und Behandlung solcher Pathologien. Durch den technischen Fortsch...

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Bibliographic Details
Main Author: Grübl, Tobias
Contributors: Kill, Clemens (Prof. Dr. med.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2019
Online Access:PDF Full Text
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Background: Metabolic or electrolyte imbalances can lead to or sustain cardiac arrest and destabilize the patient afterwards. Early detection and treatment of these pathologies is urgently demanded by guidelines. Due to technological advances preclinical emergency services are currently able to carry a portable point-of-care-testing device and gather on-site laboratory data. Methods: In this retrospective study - approved by the ethics committee - all cases of resuscitations performed outside of hospital settings by the resident emergency medical service of Marburg-Biedenkopf county (252.000 inhabitants) were analyzed over a period of 15 months (October 2015 to December 2016). The patients were followed up for a short length of time in regard to patient survival. In every case a mobile point-of-care-testing device (Alere epoc) was available. The results and frequencies of pathological deviations of preclinical point-of-care-laboratory data, the resulting therapeutic interventions, the progress and the outcome of treatment were evaluated. Results: 37 % (n=98) of 263 patients suffering from out-of-hospital cardiac arrest received a point-of-care-laboratory. Of those measurements pronounced metabolic acidosis (pH<7.2, BE<-5 mmol/l) was found in 63 %, relevant deviations of potassium level (>6.0 mmol/l, <2.5 mmol/l) in 17 % and divergences of the physiological potassium value (3.5-5.2 mmol/l) in 34 %. 81 % of patients in severe acidosis were treated with sodium bicarbonate. 22 % of all patients receiving a point-of-care laboratory obtained potassium-specific therapy. There was no statistically significant loss of on-scene time concerning the treatment of patients by implementing point-of-care-testing. In 53 % of the surviving patients the emergency medical service provided a point-of-care-laboratory. Conclusion: A point-of-care-laboratory regarding preclinical resuscitation of patients is fast and easy to perform. In the majority of patients relevant deviations of laboratory values can be found and their treatment could lead to an improvement in therapy of patients suffering from out-of-hospital cardiac arrest.