Zusammenfassung
Das Outcome nach Kreislaufstillstand und kardiopulmonaler Reanimation hängt von entscheidenden Interventionen ab, besonders frühzeitiger Defibrillation, effektiver Thoraxkompression und erweiterten lebensrettenden Maßnahmen. Die Definitionen und Berichtsschemata des Utstein-Style sind in publizierten Studien zum Kreislaufstillstand intensiv genutzt worden, und dies hat zu einem größeren Verständnis der Elemente der praktischen Reanimation geführt sowie zum Fortschritt in Richtung eines internationalen Konsenses über Wissenschaft und Richtlinien der Reanimation. Trotz der Entwicklung der Utstein-Schemata zur Standardisierung von Forschungsberichten über Kreislaufstillstand müssen internationale Register erst noch geschaffen werden. Im April 2002 traf sich eine Taskforce in Melbourne, Australien, um die weltweiten Erfahrungen mit den Utstein-Definitionen und -Schemata zu bewerten. Die Taskforce überarbeitete im Konsens das hauptsächliche Berichtsschema und die Definitionen. Es wurde Wert darauf gelegt, auf vorhandenen Definitionen aufzubauen sowie Datenelemente und operationale Definitionen nur zu ändern, wenn publizierte Daten und Erfahrungen aus Registern, die den Utstein-Style verwendet hatten, dafür eine Grundlage boten. Das Augenmerk lag darauf, die Komplexität bestehender Schemata zu verringern und logistische Schwierigkeiten bei der Erhebung spezieller Kern- oder zusätzlicher Daten (d. h. essenziell und wünschenswert), die von früheren Utstein-Konsensuskonferenzen empfohlen worden waren, zu berücksichtigen. Ebenso befasste man sich mit Widersprüchen zwischen der Terminologie von innerklinischen und außerklinischen Utstein-Schemata. Die Taskforce hat ein Hilfsmittel zur Darstellung essenzieller Daten erstellt, das sowohl zur Qualitätsverbesserung (Register) als auch für Forschungsberichte verwendet werden kann und das für Erwachsene ebenso geeignet ist wie für Kinder. Das revidierte und vereinfachte Schema beinhaltet praktische und knappe operationale Definitionen. Es ist zu erwarten, dass das überarbeitete Schema dazu beiträgt, bessere und exaktere Berichte über alle Kreislaufstillstände und Reanimationsversuche anzufertigen. Probleme mit Datendefinition, Erhebung, Verlinkung, Vertraulichkeit, Management und Einführung von Registern werden angesprochen, und es werden mögliche Lösungen angeboten. Die einheitliche Sammlung und Nachverfolgung von Registerdaten soll in jedem Krankenhaus, jedem Rettungsdienst und jeder Gemeinde eine kontinuierliche Qualitätsverbesserung ermöglichen.
Abstract
Outcome following cardiac arrest and cardiopulmonary resuscitation is dependent on critical interventions, particularly early defibrillation, effective chest compressions, and advanced life support. Utstein-style definitions and reporting templates have been used extensively in published studies of cardiac arrest, which has led to a greater understanding of the elements of resuscitation practice and progress towards an international consensus on science and resuscitation guidelines. Despite the development of Utstein templates to standardize research reports on cardiac arrest, international registries have yet to be developed. In April 2002, a task force from ILCOR met in Melbourne, Australia, to review worldwide experience with the Utstein definitions and reporting templates. The task force revised the core reporting template and definitions by consensus. Care was taken to build on previous definitions, changing data elements and operational definitions only on the basis of published data and experience derived from those registries that have used Utstein-style reporting. Attention was focused on decreasing the complexity of the existing templates and addressing logistical difficulties in collecting specific core and supplementary (i.e., essential and desirable) data elements recommended by previous Utstein consensus conferences. Inconsistencies in terminology between in-hospital and out-of-hospital Utstein templates were also addressed. The task force produced a reporting tool for essential data that can be used for both quality improvement (registries) and research reports, and that should be applicable to both adults and children. The revised and simplified template includes practical and succinct operational definitions. It is anticipated that this revised template will enable better and more accurate completion of all reports on cardiac arrest and resuscitation attempts. Problems with data definition, collection, linkage, confidentiality, management, and registry implementation are acknowledged and potential solutions offered. Uniform collection and tracking of registry data should enable better continuous quality improvement within every hospital, EMS system, and community.
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Danksagung
Im Jahr 1991 schrieben die Autoren der ursprünglichen Utstein-Leitlinien zur einheitlichen Erfassung, dass „gewisse Merkmale der Utstein-Leitlinien überarbeitet und ergänzt werden müssen“. Die Empfehlungen dieses Beitrags gehen direkt aus Arbeiten hervor, die in früheren Utstein-Konsensuskonferenzen und beratenden Stellungnahmen von ILCOR publiziert wurden. Besondere Anerkennung gebührt Richard Cummins, Douglas Chamberlain und Peter Safar, die die Welt dazu gebracht haben zu kooperieren, um die Pathophysiologie des Kreislaufstillstandes und der Reanimation zu verstehen. Wir widmen diese Fortschreibung ihren Anstrengungen sowie den vielen Wissenschaftlern, die danach streben, dass ihr Traum Realität wird.
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Jacobs, I., Nadkarni, V., Bahr, J. et al. Berichte über Kreislaufstillstände und kardiopulmonale Reanimationen. Notfall + Rettungsmedizin 8, 320–333 (2005). https://doi.org/10.1007/s10049-005-0754-2
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DOI: https://doi.org/10.1007/s10049-005-0754-2