Reanimation nach Traumap100527.typo3server.info/images/DIVIKongress/DIVI2015/03.12.2015... · m)...

Bundeswehrkrankenhaus UlmAkademisches Krankenhaus der Universität Ulm

Klinik für Anästhesie und Intensivmedizin

Sektion Notfallmedizin

Dr. Martin Kulla, DESA

Dr. Martin Kulla, DESA Klinik für Anästhesiologie und Intensivmedizin


Bundeswehrkrankenhaus Ulm

Reanimation nach Trauma

...Zeit zum Umdenken!





Einsatzmeldung Verkehrsunfall





Einsatzmeldung: Verkehrsunfall





Einsatzmeldung Verkehrsunfall

Aspekte der Traumareanimation

Fallberichte

Erfahrung

Misserfolge

Erkenntnisse

ZukünftigesPraktisches

Was ist im

Sinne des

Patienten?Ethik

Therapie Prähospital

Schockraum

InzidenzLeitlinien und

Literatur

Outcome

Maßnahmen

Algorithmen

Ursachen

Indikation und Abbruch





Inzidenz

Ursachen des prähospitalen Herzkreislaufstillstandes in Australien

Deasy C, Bray J, Smith K et al. Traumatic out-of-hospital cardiac arrests in Melbourne,

Australia. Resuscitation 2012; 83: 465-470





Ursachen des Kreislaufstillstands 2013 im deutschen

Reanimationsregister

0

10

20

30

40

50

60

70

kardial Trauma Ertrinken Hypoxie sonstiges

Chr. 22

gesamt

Deutsches Reanimationsregister - RTH Christoph 22






Kein ROSC

Patient verstirbt






Verlauf

ROSC nach

Blutungskontrolle,

Volumentherapie

und unter offener

HDM

Durchschuss Aorta

abdominalis

Aortenersatz im SR

Tod: 6 Stunden post

OP auf ICU






Notthorakotomie im Schockraum






Exsanguination

aufgrund

Mittelgesichtstrauma

Prähospital keine

Möglichkeit der

Blutstillung






• ROSC nach Blutstillung

und Volumengabe

• Operative Versorgung






„persönliche NNT aktuell 10“

NNH ???






Rosemurgy AS, Norris PA, Olson SM, Hurst JM, Albrink MH. Prehospital traumatic cardiacarrest: the cost of futility. J Trauma 1993; 35: 468-473; discussion 473-464

12.462 Trauma

? (?%) OHCA

138 (?%) Trauma-

CPR

? (?%) ROSC

0 (0%) Überleben

Trauma patients who require CPR at the scene or in

transport die. Infrequent organ procurement does not

seem to justify the cost (primarily borne by hospitals),

consumption of resources, and exposure of health care

providers to occupational health hazards. The wisdom of

transporting trauma victims suffering cardiopulmonary

arrest at the scene or during transport must be

questioned





ERC Guideline 2010

Soar J, Perkins GD, Abbas G et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2010; 81: 1400-1433





ERC Guideline 2015

Truhlar A et. al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in

special circumstances. Resuscitation 95 148-201 (2015)





Trauma-CPR

DSTC® Kurs – mit freundlicher Genehmigung von Sascha Flohé





CPR

Trauma-CPR

≠





Autoren Section 4

a) Emergency Medical Services of the Hradec Králové

Region, Hradec Králové, Czech Republic

b) Department of Anaesthesiology and Intensive Care

Medicine, University Hospital Hradec Králové, Hradec

Králové, Czech Republic

c) Cardiac Anaesthesia and Cardiac Intensive Care, NIHR

Southampton Respiratory Biomedical Research Unit,

Southampton University Hospital NHS Trust,Southampton,

UK

d) Anaesthesia and Intensive Care Medicine, Southmead

Hospital, North Bristol NHS Trust, Bristol, UK

e) Emergency and Disaster Medicine, Six October University

Hospital, Cairo, Egypt

f) Departments of Renal and Internal Medicine, Victoria

Hospital, Kirkcaldy, Fife, UK

g) Society to Rescue People from Drowning, Amsterdam, The

Netherlands

h) Bergen Emergency Medical Services, Department of

Anaesthesia and Intensive Care, Haukeland University

Hospital, Bergen, Norway

i) EURAC Institute of Mountain Emergency Medicine, Bozen,

Italy

j) Department of Cardiothoracic Surgery, James Cook

University Hospital, Middlesbrough, UK

k) Center for Emergency Medicine, Clinical Hospital Center

Zagreb, Zagreb, Croatia

l) Department of Cardiology, Academic Medical Center,

Amsterdam, The Netherlands

m) Intensive Care Medicine and Anaesthesia, Southmead

Hospital, North Bristol NHS Trust, Bristol, UK

n) Department of Anesthesiology, University Medical Center,

Johannes Gutenberg-Universitaet, Mainz, Germany

o) Barts Heart Centre, St Bartholomew’s Hospital, Barts

Health NHS Trust, Queen Mary University of London,

London, UK

p) Department of Anaesthesiology and Critical Care Medicine,

University Hospital Innsbruck, Austria

q) Warwick Medical School, University of Warwick, Coventry,

UK

r) Critical Care Unit, Heart of England NHS Foundation Trust,

Birmingham, UK

s) Department of Anaesthesiology and Intensive Care,

Catholic University School of Medicine, Rome, Italy

t) Birmingham Children’s Hospital, Birmingham, UK

u) Department of Anaesthetics, Imperial College Healthcare

NHS Trust, London, UK

v) Anaesthesia and Intensive Care Medicine, Royal United

Hospital, Bath, UK

w) School of Clinical Sciences, University of Bristol, UK





Collaborators Section 4

Intensive Care Medicine and Clinical Toxicology,Catholic University School of

Medicine, Rome, ItalyBernd

´Department of Anaesthesiology and IntensiveCare Medicine, University Hospital

of Cologne, Cologne, Germany

American Medical Center Nicosia, Cyprus

Honorary Consultant Physician, Colchester, UK

Department of Anaesthesiology and Intensive Care,Stavanger University Hospital,

Stavanger, Norway; Norwegian AirAmbulance Foundation, Drøbak, Norway

NIHR Surgical Reconstruction and Microbiology Research Centre, University of

Birmingham, UK

Emergency Medicine, Faculty of Medicineand Health Sciences, University of

Antwerp, Antwerp, Belgium / Faculty of Medicine and Health Sciences, University

of Ghent,Ghent, Belgium; Emergency Medicine, Ghent University, Ghent,

Belgium

Department of Anaesthesiology and IntensiveCare Medicine, University Hospital

of Cologne, Cologne, Germany





ERC Guideline 2015

There are no reliable predictors of survival for traumatic cardiac arrest.

A large systematic review reported an overall survival rate of 3.3% in blunt

and 3.7% in penetrating trauma, with good neurlogical outcome in 1.6% of

all cases

One study reported good neurological outcome in 36.4% of TCA patients

presenting with VF, but only in 7% with PEA and 2.7% of those in asystole...

For reasons that are unclear, reported survival rates in the last 5 years

are better than reported previously. In those who survive (and where data

are available) neurological outcome is good in only 1.6% of those sustaining

traumatic cardiorespiratory arrest (ERC Guideline 2010)

Truhlar A et. al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac

arrest in special circumstances. Resuscitation 95 148-201 (2015)





ERC Guideline 2015

Truhlar A et. al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac

arrest in special circumstances. Resuscitation 95 148-201 (2015)

1. Emphasis on rapid treatment of all potentially reversible pathology is the

basis of treatment guidelines.

• Hypoxaemia (oxygenation, ventilation).

• Compressible haemorrhage (pressure, pressure dressings,

tourniquets,novel haemostatic agents).

• Non-compressible haemorrhage (splints, intravenous fluid).

• Tension pneumothorax (chest decompression).

• Cardiac tamponade (immediate thoracotomy)

2. Chest compressions: although they may not be effective in hypovolaemic

cardiac arrest most survivors do not have hypovolaemia and in this

subgroup standard advanced life support may be lifesaving.

3. Standard CPR should not delay the treatment of reversible causes

(e.g., thoracotomy for cardiac tamponade).

4. Do not delay for unproven interventions such as spinal immobilisation.





Leitlinie Schwerstverletztenversorgung

Deutsche Gesellschaft für Unfallchirurgie, Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin et al. S3 Leitlinie Polytrauma - AWMF-Register Nr. 012/019: AWMF; 2011

PrähospitalphaseKEINE Aussage

SchockraumBei definitiv vorliegendem Herzkreislauf-

stillstand, bei Unsicherheiten im Nachweis

eines Pulses oder bei anderen klinischen

Zeichen, die einen HKS wahrscheinlich

machen, soll unverzüglich mit der

Reanimation begonnen werden. (GoR A)





Rosemurgy AS, Norris PA, Olson SM, Hurst JM, Albrink MH. Prehospital traumatic cardiac arrest: thecost of futility. J Trauma 1993; 35: 468-473; discussion 473-464

12.462 Trauma

? (?%) OHCA

138 (?%) Trauma-CPR

? (?%) ROSC

0 (0%) Überleben

Tabelle 6:Causes of death in 138 patients experiencing prehospital

cardiopulmonary arrest prior to or during transport to county trauma

centers:

Exsanguination 42

Closed head injury 31

Multiple organ system injuries 29

Cardiac injuries 12

Pneumohemothorax 7

Progression of preterminal state 4

Coagulopathy 3

High spinal injury 3

Traumatic asphyxia 3

Hypoxia/anoxia 2

Pulmonary edema 1

Late septic death 1

Summe: 138

ABER:

mind. 14 (10%) potentiell

überlebbare

Todesursachen!





Fialka C, Sebok C, Kemetzhofer P et al. Open-chest cardiopulmonary resuscitation after cardiac arrest in casesof blunt chest or abdominal trauma: a consecutive series of 38 cases. J Trauma 2004; 57: 809-814

38 (100%) stumpfes

Rumpftrauma mit

max. 20min CCCPR

prähospital und

OCCPR im SR

4 (10,5%) überleben





ROSC after cardiac arrest

Gräsner JT, Meybohm P, Lefering R et al. ROSC after cardiac arrest--the RACA score topredict outcome after out-of-hospital cardiac arrest. Eur Heart J 2011; 32: 1649-1656

X=

0.3

+ (-0.2 männlicher Patient)

+ (-0.2 Patientenalter ≥80 Jahre)

+ (-0.6 Trauma) + (0.7 Hypoxie) + (0.5 Intoxikation)

+ (0.6 durch Laien) + (0.5 durch professionelles Personal beobachtet)

+ (-0.3 Pflegeheim) + (1.2 Arztpraxis) + (0.3 öffentlicher Raum) + (0.5 Krankenhaus)

+ (-0.8 PEA) + (-1.1 Asystole)

+ (0.2 Laienreanimation)

+ (-0.04 pro Minute bis Rettungsdienst ankommt)

Probability of ROSC =

1

(1 + e )-X

Konstante

Geschlecht?

Alter?

Ursache?

Beobachtet?

Ort?

EKG?

Laienreanimation

Dauer?

Aber: nicht für den Individuellen Patient

einsetzbar!





0%

10%

20%

30%

40%

50%

60%

70%

0 10 20 30 40 50 60

RO

SC W

ahrs

chei

nlic

hke

it g

em R

AC

A

Zeit [min]






0%

10%

20%

30%

40%

50%

60%

70%

0 10 20 30 40 50 60

RO

SC W

ahrs

chei

nlic

hke

it g

em R

AC

A

Zeit [min]


40 Jahre alt, kardialer Ursache,

im, EKG Kammerflimmern

80 Jahre alt, kardialer Ursache,

EKG Kammerflimmen

• 40 Jahre alt

• Trauma als Ursache

• EKG Kammerflimmern

40 Jahre alt, kardialer

Ursache EKG PEA

80 Jahre alt, kardialer

Ursache, EKG PEA





Outcome

Gräsner JT, Wnent J, Seewald S et al. Cardiopulmonary resuscitation traumatic cardiac arrest--there aresurvivors. An analysis of two national emergency registries. Crit Care 2011; 15: R276

Zusammenführung der Ergebnisse aus

Deutschem Reanimationsregister

TraumaRegister DGU®





Outcome

Gräsner JT, Wnent J, Seewald S et al. Cardiopulmonary resuscitation traumatic cardiac arrest--there are survivors. An analysis of two national emergency registries. Crit Care 2011; 15: R276

Traumatic Prehospital Cardiac Arrest 100%

ROSC 29%

Hospital admission after ROSC 26%

24h Survivial 13%

Discharged alive 7%

Discharged home 2%

De

uts

ch

es

Re

an

ima

tio

nsre

gsite

r

Tra

um

aR

eg

iste

r D

GU

®

n=368

n=107

n=95 n=814

n=369

n=221

n=56






Therapie





ERC Guideline 2015

Truhlar A et. al. European Resuscitation Council Guidelines forResuscitation 2015: Section 4. Cardiac arrest in special circumstances.Resuscitation 95 148-201 (2015)

1. Treatment of reversible causes:









subgroup standard advanced life support may be life-saving.

3. Standard CPR should not delay the treatment of reversible causes (e.g.,

thoracotomy for cardiac tamponade).






Atemwegsmanagement

„Treatment of reversible Causes“

ERC Guideline 2015:

Hypoxaemia due to airway obstruction and

traumatic asphyxia has been reported as cause of

TCA in 13% of all cases.

Tracheal intubation in traumapatients is a difficult

procedure with a high failure rate if carried out by

less experienced care providers.

Use basic airway manoeuvres and second-

generation supraglottic airways to maintain

oxygenation if tracheal intubation cannot be

accomplished immediately.

NEU: KEIN Surgical Airway





Blutung nach Aussen


ERC Guideline 2015:

Uncontrolled haemorrhage is the cause of TCA in

48% of all TCA.

The main principle is to achive ‘haemostasis without

delay’, usually with surgical or radiological intervention.

Treat compressible external haemorrhage with direct

pressure (with or without a dressing), use tourniquets if

needed and/orapply topical haemostatic agents

Non-compressible haemorrhage is more difficult. Use

splints(pelvic splint), blood products, intravenous fluids

and tranexamicacid while moving the patient to surgical

haemorrhage control.





Kritische Blutung

Kulla M, Josse F, Helm M, Lampl L, Hossfeld B. Prähospitale Traumaversorgung - Versorgung kritischer

Blutungen, in DIVI Jahrbuch 2015/2016, S Kluge, A Markewitz, G Jorch, C Putensen, M Quintel, GW Sybrecht,

Editors. 2015, MWV - Medizinisch Wissenaschaftliche Verlagsgesellschaft: Berlin, Deutschland. 351-359.





Beckenschlinge

Problem:

Kontinuierliche Blutung aus

venösen Gefäßen im

Plexus Sakralis





Kritische Blutung nach Innen?


ERC Guideline2015:

„Non-compressible haemorrhage is more

difficult. Use splints (pelvic splint), blood

products, intravenous fluids and

tranexamicacid while moving the patient to

surgical haemorrhage control.“

Beckenschlinge (RTH Chr 22 SOP)

Reposition und Schienung?

CAVE: Versorgungszeit?





Kritische Blutung





Pleuraentlastung


ERC Guideline 2015:

13% of all cases of TCA are caused by tension

pneumothorax.

...perform bilateral thoracostomies in the 4th

intercostal space, extending to a clamshell

thoracotomy if required.

In the presence of positive pressure

ventilation, thoracostomies are likely to be

more effective than needle thoracocentesis

and quicker than inserting a chest tube





Perikardentlastung

„Treatment of Reversible Causes“

ERC Guideline 2015:

..is the underlying cause of 10% of TCA.

Where there is TCA and penetrating trauma to the

chest or epigastrium, immediate resuscitative

thoracotomy via a clamshell incision can be life

saving.

ERC Guideline 2010 prähospital:

In patients with suspected trauma-related cardiac

tamponade, needle pericardiocentesis is probably

not a useful procedure.





ERC Guideline 2015















✓





Herzdruckmassage

ERC Guideline 2015:

Chest compressions are still the standard of care in

patients with cardiac arrest, irrespective of aetiology.

In cardiac arrest caused by hypovolaemia, cardiac tamponade

or tension pneumothorax, chest compressions are unlikely to

be as effective as in normovolaemic cardiac arrest.

Because of this fact, chest compressions take a lower

priority than the immediate treatment of reversible causes,

e.g. thoracotomy, controlling haemorrhage, etc.

In an out-of-hospital setting, only essential lifesaving

interventions should be performed onscene followed by rapid

transfer to the nearest appropriate hospital





Herzdruckmassage

ERC Guideline 2015

„In cardiac arrest caused by hypovolaemia, cardiac tamponade or tension

pneumothorax, chest compressions are unlikelyto be as effective as in

normovolaemic cardiac arrest.“





Herzdruckmassage

Mechanische Reanimationshilfen





Zugang zum venösen System

Sheldon Katheter periphervenöser Zugang intraossär





Volumengabe

ERC Guideline 2015 (prähospital)

Uncontrolled haemorrhage is the cause of trau-matic

cardiac arrest in 48% of all TCA

Limited evidence and general consensus have supported a

conservative approach to intravenous fluid infusion, with

permissive hypotension until surgical haemostasis is

achieved.

Spahn DR, Bouillon B, Cerny V et al. Management of

bleeding and coagulopathy following major trauma: an

updated European guideline. Crit Care 2013; 17: R76

AWMF S3 Leitlinie Intravasale Volumentherapie beim

Erwachsenen AWMF Register-Nr.: 001/020

Intravasale Blutverluste sind

durch VOLUMEN ZU ERSETZEN





Katecholamine

ERC Guidelines 2015

• The possible role of vasopressors (e.g., vasopressin) in trauma resuscitation

is unclear and is based mainly on case reports

Suprarenin Vasopressoren

???

Siehe auch:

Chiang WC et al. Prehospital intravenous epinephrine may boost survival of patients with traumatic cardiac arrest:

a retrospective cohort study. Scand J Trauma Resusc Emerg Med 23 (1): 102 (2015)

Jacobs IG et al. Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind

placebo-controlled trial. Resuscitation 82 (9): 1138-1143 (2011)





Vasopressoren

Fallberichte zu Vasopressoren

• Krismer AC, Wenzel V, Voelckel WG et al. Employing vasopressin as an adjunct vasopressor in uncontrolled traumatic hemorrhagic shock. Threecases and a brief analysis of the literature. Anaesthesist 2005; 54: 220-224

Vasopressoren

???





Defibrillation

ERC Guidelines 2015:

Grundsatz:

– Ja, bei Kammerflimmern immer

CAVE:

– Soll die Therapie reversibler Ursachen

nicht behindern...





ERC Guideline 2015



















Prähospitale Trauma-CPR

Indikation zur Trauma-CPR?

Therapie reversibler Ursachen

Reevaluation

Beckenschlinge / Schienung

erwägen

HypoxieSpannungs-

pneumothoraxKatastrophale

Blutung

Perikardtam-

ponade

Tourniquet bei V.a.

Extremitätentrauma

Transport in nächstes Traumazentrum unter CPR gem. ERC Leitlinie

HDM

Defibrillation?

HDM

Supra-

renin

Anmel-

dung

Sonstige

Maßnahmen





Publikation Gässler et al. Mai 2015

Gässler H, Helm M, Lampl L, Kulla M. Cardiopulmonary Resuscitation after Traumatic Event. Notarzt 31 (4): 210-

216 (2015)





Trauma-CPR (ERC Guideline 2015)






Sonstige Therapieoptionen





Einsatztaktik HEMS – London 1/2

Sherren PB, et al.: Algorithm for the resuscitation of traumatic cardiac arrest patients in a physician-staff ed helicopter emergency medical service. Critical Care 2013, 17:308.





Einsatztaktik HEMS – London 2/2

Sherren PB, et al.: Algorithm for the resuscitation of traumatic cardiac arrest patients in a physician-staff ed helicopter emergency medical service. Critical Care 2013, 17:308.





ERC Guidelines 2015

Notfallthorakotomie (RT)

The prerequisites for a successful RT can be summarised as the ‘four Es rule’ (4E):

Expertise: teams that perform RT must be led by a highly trained and competent

healthcare practitioner.

Equipment: adequate equipment to carry out RT and to deal with the

intrathoracic findings is mandatory

Environment: ideally RT should be carried out in an operating theatre. RT

should not be carried out if there is inadequate physical access to the patient, or

if the receiving hospital is not easy to reach.

Elapsed time: the time from loss of vital signs to commencing aRT should not be

longer than 10 min.

If any of the four criteria is not met, RT is futile and exposes the team to

unnecessary risks.





Tranexamsäure

Ker K, Kiriya J, Perel P et al. Avoidable mortality from giving tranexamic acid tobleeding trauma patients: an estimation based on WHO mortality data, a systematicliterature review and data from the CRASH-2 trial. BMC Emerg Med 2012; 12: 3

Bei Schwersteverletzten mit Verdacht auf

Hyperfibrinolyse

1g als Bolus i.v. prähospital

1g über 8 Stunden innerklinisch





Temperaturmanagement

34.0°C





Aktuell: Normothermie bei Trauma + CPR

36.5°C






Einsatztaktik





Einsatztaktik - Notarzt

Klein KR. Traumatic cardiac arrests - the action or the provider, what makes thedifference? Crit Care 2013; 17: 156

... In multiple European studies it was noted that

there was a decrease in mortality of trauma

patients without a decrease in scene time when a

physician was part of the flight crew . In the US,

less than 5% of HEMS are staffed by physicians, and

most of those involved in such teams are in their first

few years out of medical school . Thus, no US EMS

systems have fully trained physicians as part of their

standard ambulance crew...





Einfluss des Rettungsmittels

Di Bartolomeo S, Sanson G, Nardi G, Michelutto V, Scian F. HEMS vs. Ground-BLS care in traumatic

cardiac arrest. Prehosp Emerg Care 2005; 9: 79-84





Einsatztaktik bei Trauma-CPR

ERG Guideline 2015

Prehospital care. Short prehospital times are

associated with increased survival rates for major

trauma and TCA. The time elapsed between injury

and surgical control of bleeding should therefore be

minimised and the patient should be immediately

transferred to a trauma centre for ongoing damage

control resuscitation.

A ‘scoop and run’ concept for these patients may be

life saving.





Personelle Resourcen

Lehren aus dem eigenen Bereich

• Teamleader (erfahrenster Oberarzt)

• Operativ

– 2 Chirurgen

– 2 OP Pfleger

• Anästhesie

– 2 Anästhesisten

– 1 Fachschwester Anästhesie

• Bildgebung

– Facharzt Radiologie

– MTRA

• ZINA

– 2 Pflegekräfte

– 1-2 Springer

– Dokumentation

• Weiter Fachdisziplinen (Facharzt mit Entscheidungskompetenz!)

ca. 17 Beteiligte





Innerklinische Bildgebung

eFAST Trauma-

spirale

???





REBOA

Stannard A, Eliason JL, Rasmussen TE. Resuscitative endovascular balloon occlusion ofthe aorta (REBOA) as an adjunct for hemorrhagic shock. J Trauma 2011; 71: 1869-1872





Herzkreislaufunterstützung

Tseng YH, Wu TI, Liu YC, Lin PJ, Wu MY. Venoarterial extracorporeal life support in post-traumatic shockand cardiac arrest: lessons learned. Scand J Trauma Resusc Emerg Med 2014; 22: 12

Endergebnis

• Gräsner JT, Wnent J, Seewald S et al. Cardiopulmonary resuscitation traumatic cardiac arrest--there aresurvivors. An analysis of two national emergency registries. Crit Care 2011; 15: R276

• Smith K, Andrew E, Lijovic M, Nehme Z, Bernard S. Quality of Life and Functional Outcomes 12 Months After Out-of-Hospital Cardiac Arrest. Circulation 2015; 131: 174-181

Reanimation in Australien (med. Ursache)• 40% Transport ins Krankenhaus• 35% ROSC auf Transport oder im Krankenhaus• 13% Klinkentlassung• 6-8% mit gutem Ergebnis

Trauma im SR

ISS 24±12

100% Klinikaufnahme86% Klinikentlassung50% gutes Ergebnis

Reanimation nach Trauma30-45% ROSC10-15% Klinikaufnahme5-10% Klinikentlassung2-5% gutes neurologisches Ergebnis






Abbruchkriterien





Trauma-CPR – Pro und Contra

Reanimation nach Trauma indiziert

Potentiell überlebbare Verletzung

Beobachteter HKST

Laufende Laienreanimation

Kammerflimmern

Reversible Ursachen noch nicht ausgeschlossen

KEINE Indikation

Mehrere Verletzte

Sichere Todeszeichen

Nicht überlebbares Trauma





Trauma-CPR – Pro und Contra

Reanimation indiziert

Potentiell überlebbare

Verletzung

Beobachteter HKST

Laufende Laienreanimation

Kammerflimmern / PEA

Reversible Ursachen noch

nicht ausgeschlossen

Fraglich

Einfluss des

Verletzungsmechanismus

Patientenalter

Fahrzeit bis Klinik >15min

Asystolie

KEINE Indikation

Mehrere Verletzte

Sichere Todeszeichen

Nicht überlebbares Trauma

???






Zusammenfassung





Prähospitale Reanimation nach Trauma

CPR ≠ Trauma-CPR

Indikation!

Das Team ist entscheidend!





Dr. Martin Kulla, DESAKlinik für Anästhesie und IntensivmedizinBundeswehrkrankenhaus UlmOberer Eselsberg 4089081 Ulm

[email protected]

Vielen Dank

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