Clamshell-Thorakotomie im Rettungsdienst und Schockraum: Indikationen, Anforderungen und Technik

Marcus Rudolph; Tim Lange; Martin Göring; Niko R. E. Schneider; Erik Popp

doi:10.1055/a-0869-7162

NOTARZT, Table of Contents

NOTARZT 2019; 35(04): 199-207
DOI: 10.1055/a-0869-7162

Übersicht

Georg Thieme Verlag KG Stuttgart · New York

Clamshell-Thorakotomie im Rettungsdienst und Schockraum: Indikationen, Anforderungen und Technik

Resuscitative Clamshell-Thoracotomy in Prehospital and Inhospital Emergency Medicine: Indications, Requirements and Technique

Marcus Rudolph

¹Fachbereich Medizin, DRF Stiftung Luftrettung gemeinnützige AG, Filderstadt

²Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsmedizin Mannheim

,

Tim Lange

³Klinik für Anästhesie, Intensiv-, Rettungs- und Schmerzmedizin, BG Klinikum Hamburg

,

Martin Göring

⁴Klinik für Anästhesiologie Sektion Notfallmedizin, UniversitätsKlinikum Heidelberg

,

Niko R. E. Schneider

⁴Klinik für Anästhesiologie Sektion Notfallmedizin, UniversitätsKlinikum Heidelberg

,

Erik Popp

⁴Klinik für Anästhesiologie Sektion Notfallmedizin, UniversitätsKlinikum Heidelberg

› Author Affiliations

Abstract

Zusammenfassung

Die Notfallthorakotomie beim traumatischen Herz-Kreislauf-Stillstand spielte in Deutschland lange Zeit eine untergeordnete Rolle. Nach der Veröffentlichung der Reanimationsleitlinien des ERCs 2015 rückte der Algorithmus zur Versorgung dieses Verletzungsmusters in den Mittelpunkt, und speziell die Notfallthorakotomie war Auslöser einiger kontroverser Diskussionen. Die vorliegende Arbeit beschreibt nun die Indikationen für eine Thorakotomie im Rahmen einer Reanimation und erläutert die nötigen Rahmenbedingungen. Weiterhin wird die Technik Schritt für Schritt beschrieben. Darüber hinaus erfolgt eine kritische Betrachtung der Implementierung der Technik in unser Rettungsdienstsystem sowie der Hinweis auf bestehende Schulungskonzepte.

Abstract

In Germany in the past resuscitative thoracotomy in traumatic cardiac arrest did not get a lot of attention. With the publication of the 2015 ERC Guidelines the revised algorithm for the treatment of reversible causes of traumatic cardiac arrest gained a lot of attention, highlighting the possibly lifesaving impact of resuscitative thoracotomy, hence sparking some controversial discussions. The aim of this paper is to give a step by step description of the technique and to describe indications for resuscitative thoracotomy and to highlight the required prerequisites. Furthermore it provides a critical review of the implementation of resuscitative thoracotomy into a pre hospital care system and summarizes current training concepts.

Schlüsselwörter

Clamshell-Thorakotomie - traumatischer Herz-Kreislauf-Stillstand - Herzbeuteltamponade

Key words

Clamshell-thoracotomy - resuscitative thoracotomy - traumatic cardiac arrest - pericardial tamponade

Full Text

References

Literatur
1 Becker G. Messerangriffe: Uneindeutige Daten und fragwürdige Behauptungen. Im Internet: https://www.zeit.de/politik/deutschland/2018-03/messerangriffe-statistiken-innenministerium-debatte Stand: 06.01.2019
2 Truhlář A, Deakin CD, Soar J. et al. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95: 148-201 doi:10.1016/j.resuscitation.2015.07.017
3 Davies GE, Lockey DJ. Thirteen Survivors of Prehospital Thoracotomy for Penetrating Trauma: A Prehospital Physician-Performed Resuscitation Procedure That Can Yield Good Results. J Trauma 2011; 70: E75-E78 doi:10.1097/TA.0b013e3181f6f72f
4 Corral E, Silva J, Suárez RM. et al. A Successful Emergency Thoracotomy Performed in the Field. Resuscitation 2007; 75: 530-533 doi:10.1016/j.resuscitation.2007.06.025
5 Rudolph M, Schneider NR, Popp E. Clamshell-Thorakotomie nach thorakalen Messerstichen. Unfallchirurg 2017; 120: 344-349 doi:10.1007/s00113-016-0287-9
6 Puchwein P, Prenner G, Fell B. et al. Erfolgreiche präklinische Thorakotomie bei einem 17-jährigen Mann. Unfallchirurg 2014; 117: 849-852 doi:10.1007/s00113-013-2484-0
7 Lustenberger T, Labler L, Stover JF. et al. Resuscitative Emergency Thoracotomy in a Swiss Trauma Centre. Br J Surg 2012; 99: 541-548 doi:10.1002/bjs.7706
8 Narvestad JK, Meskinfamfard M, Søreide K. Emergency Resuscitative Thoracotomy Performed in European Civilian Trauma Patients with Blunt or Penetrating Injuries: A Systematic Review. Eur J Trauma Emerg Surg 2016; 42: 677-685 doi:10.1007/s00068-015-0559-z
9 Lockey D, Crewdson K, Davies G. Traumatic Cardiac Arrest: Who Are the Survivors?. Ann Emerg Med 2006; 48: 240-244 doi:10.1016/j.annemergmed.2006.03.015
10 Mitchell TA, Waldrep KB, Sams VG. et al. An 8-Year Review of Operation Enduring Freedom and Operation Iraqi Freedom Resuscitative Thoracotomies. Mil Med 2015; 180: 33-36 doi:10.7205/MILMED-D-14-00440
11 Kleber C, Giesecke MT, Lindner T. et al. Requirement for a Structured Algorithm in Cardiac Arrest Following Major Trauma: Epidemiology, Management Errors, and Preventability of Traumatic Deaths in Berlin. Resuscitation 2014; 85: 405-410 doi:10.1016/j.resuscitation.2013.11.009
12 Adler Y, Charron P, Imazio M. et al. 2015 ESC Guidelines for the Diagnosis and Management of Pericardial Diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015; 36: 2921-2964 doi:10.1093/eurheartj/ehv318
13 Van Vledder MG, Van Waes OJF, Kooij FO. et al. Out of Hospital Thoracotomy for Cardiac Arrest after Penetrating Thoracic Trauma. Injury 2017;
14 Slessor D, Hunter S. To Be Blunt: Are We Wasting Our Time? Emergency Department Thoracotomy Following Blunt Trauma: A Systematic Review and Meta-Analysis. Ann Emerg Med 2015; 65: 297-307.e16 doi:10.1016/j.annemergmed.2014.08.020
15 Sherren PB, Reid C, Habig K. et al. Algorithm for the Resuscitation of Traumatic Cardiac Arrest Patients in a Physician-Staffed Helicopter Emergency Medical Service. Crit Care 2013; 17: 308 doi:10.1186/cc12504
16 Degiannis E, Bonanno F, Titius W. et al. Treatment of penetrating injuries of neck, chest and extremities. Chirurg 2005; 76: 945-958
17 Velmahos GC, Degiannis E, Doll D. Penetrating Trauma: A practical Guide on operative Technique and peri-operative Management. Berlin, Heidelberg: Springer; 2016
18 Seamon MJ, Haut ER, Van Arendonk K. et al. An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2015; 79: 159-173 doi:10.1097/TA.0000000000000648
19 Wise D. Emergency thoracotomy: “how to do It”. Emerg Med J 2005; 22: 22-24 doi:10.1136/emj.2003.012963
20 Konig T, Perkins Z, Davies G. Training Non-Surgeons to Perform Resuscitative Thoracotomy. Scand J Trauma Resusc Emerg Med 2013; 21 (Suppl. 01) A2 doi:10.1186/1757-7241-21-S1-A2
21 Timmermann A, Russo SG, Eich C. et al. The Out-of-Hospital Esophageal and Endobronchial Intubations Performed by Emergency Physicians. Anesth Analg 2007; 104: 619-623 doi:10.1213/01.ane.0000253523.80050.e9
22 Möller CT, Schoonbee CG, Rosendorff G. Haemodynamics of cardiac tamponade during various modes of ventilation. Br J Anaesth 1979; 51: 409-415 doi:10.1093/bja/51.5.409
23 Flaris AN, Simms ER, Prat N. et al. Clamshell Incision Versus Left Anterolateral Thoracotomy. Which One Is Faster When Performing a Resuscitative Thoracotomy? The Tortoise and the Hare Revisited. World J Surg 2015; 39: 1306-1311 doi:10.1007/s00268-014-2924-1
24 Puchwein P, Sommerauer F, Clement HG. et al. Clamshell Thoracotomy and Open Heart massage–A Potential Life-Saving Procedure Can Be Taught to Emergency Physicians. Injury 2015; 46: 1738-1742 doi:10.1016/j.injury.2015.05.045
25 Suzuki K, Inoue S, Morita S. et al. Comparative Effectiveness of Emergency Resuscitative Thoracotomy versus Closed Chest Compressions among Patients with Critical Blunt Trauma: A Nationwide Cohort Study in Japan. PLoS One 2016; 11: e0145963 doi:10.1371/journal.pone.0145963
26 Dahmen J, Brade M, Gerach C. et al. Erfolgreiche präklinische Notfallthorakotomie nach stumpfem Thoraxtrauma: Fallbericht mit Darstellung gewonnener Erkenntnisse. Unfallchirurg 2018; 121: 839-849 doi:10.1007/s00113-018-0516-5
27 Holcomb JB, Donathan DP, Cotton BA. et al. Prehospital Transfusion of Plasma and Red Blood Cells in Trauma Patients. Prehosp Emerg Care 2015; 19: 1-9 doi:10.3109/10903127.2014.923077
28 Reed MJ, Glover A, Byrne L. et al. Experience of Implementing a National Pre-Hospital Code Red Bleeding Protocol in Scotland. Injury 2017; 48: 41-46 doi:10.1016/j.injury.2016.09.020
29 Weaver AE, Hunter-Dunn C, Lyon RM. et al. The Effectiveness of a ‘Code Red’ Transfusion Request Policy Initiated by Pre-Hospital Physicians. Injury 2016; 47: 3-6 doi:10.1016/j.injury.2015.06.023
30 Schneider N, Küßner T, Weilbacher F. et al. Invasive Notfalltechniken – INTECH Advanced: REBOA, Perikardiozentese und Clamshell-Thorakotomie. Notf Rett Med 2019; 22: 87-99 doi:10.1007/s10049-018-0475-y
31 Lorello GR, Hicks CM, Ahmed SA. et al. Mental practice: a simple tool to enhance team-based trauma resuscitation. CJEM 2016; 18: 136-142 doi:10.1017/cem.2015.4
32 Rao A, Tait I, Alijani A. Systematic Review and Meta-Analysis of the Role of Mental Training in the Acquisition of Technical Skills in Surgery. Am J Surg 2015; 210: 545-553 doi:10.1016/j.amjsurg.2015.01.028