Hämodynamisch relevante intrathorakale Blutung nach CPR: Fallbericht über eine reanimationsassoziierte Verletzung von Interkostalarterien mit Notwendigkeit einer arteriellen Transkatheter-Embolisation

Zusammenfassung

Traumata mit Rippen(serien)- und Sternumfrakturen sind häufige Folgen einer kardiopulmonalen Reanimation. Wir stellen einen Fall vor, bei dem es infolge der Thoraxkompressionen zu einer Rippenserienfraktur mit hämodynamisch relevanter und transfusionspflichtiger Blutung aus 3 Interkostalarterien kam. Der Befund wurde mittels interventionell-radiologischer Coilembolisation therapiert. Nach kardiopulmonaler Reanimation sollten, insbesondere bei hämodynamischer Instabilität, Traumata in Betracht gezogen und aktiv gesucht bzw. ausgeschlossen werden.

Abstract

Traumata with (serial) rib and sternal fractures are common sequelae of cardiopulmonary resuscitation. In our case, chest compressions have led to serial rib fractures with hemodynamically relevant bleeding from three intercostal arteries which required transfusion. The finding was treated with interventional-radiological coil embolization. Following cardiopulmonary resuscitation, traumata should be considered and actively sought, or excluded, especially in hemodynamically instable patients.

Schlüsselwörter

Kreislaufstillstand - Reanimationstrauma - Rippenserienfraktur - Thoraxtrauma - Hämorrhagie - interventionelle Radiologie

Keywords

cardiac arrest - resuscitation trauma - serial rib fracture - thoracic Injuries - hemorrhage - interventional radiology

Publication History

Received: 25 June 2021

Accepted after revision: 13 April 2022

Article published online:
10 June 2022

• Literatur

• 1 Soar J, Nolan JP, Böttiger BW. et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support. Resuscitation 2015; 95: 100-147
• 2 Seewald S, Wnent J, Lefering R. et al. CaRdiac Arrest Survival Score (CRASS) – A tool to predict good neurological outcome after out-of-hospital cardiac arrest. Resuscitation 2019; 146: 66-73
• 3 Lukas RP, Gräsner JT, Seewald S. et al. Chest compression quality management and return of spontaneous circulation: a matched-pair registry study. Resuscitation 2012; 83: 1212-1218
• 4 Buschmann C, Kleber C. Reanimation, Reanimationsverletzungen und Folgen notärztlicher Maßnahmen. In: Madea B. Die ärztliche Leichenschau. 3. Heidelberg: Springer; 2014: 149-160
• 5 Viniol S, Thomas RP, Konig AM. et al. Early whole-body CT for treatment guidance in patients with return of spontaneous circulation after cardiac arrest. Emerg Radiol 2020; 27: 23-29
• 6 Hellevuo H, Sainio M, Nevalainen R. et al. Deeper chest compression – more complications for cardiac arrest patients?. Resuscitation 2013; 84: 760-765
• 7 Beom JH, You JS, Kim MJ. et al. Investigation of complications secondary to chest compressions before and after the 2010 cardiopulmonary resuscitation guideline changes by using multi-detector computed tomography: a retrospective study. Scand J Trauma Resusc Emerg Med 2017; 25: 8
• 8 Obermaier M. Stellenwert von Kardiokompressionssystemen in der außer- und innerklinischen Reanimation: Eine retrospektive Registeranalyse und prospektive Metaanalyse [M.D.]. Ulm: Open Access Repositorium of Ulm University (OPARU), Medizinische Fakultät, Universität Ulm; 2018: 159
• 9 Pinto DC, Haden-Pinneri K, Love JC. Manual and automated cardiopulmonary resuscitation (CPR): a comparison of associated injury patterns. J Forensic Sci 2013; 58: 904-909
• 10 Koga Y, Fujita M, Yagi T. et al. Effects of mechanical chest compression device with a load-distributing band on post-resuscitation injuries identified by post-mortem computed tomography. Resuscitation 2015; 96: 226-231
• 11 Karasek J, Blankova A, Doubkova A. et al. The comparison of cardiopulmonary resuscitation-related trauma: Mechanical versus manual chest compressions. Forensic Sci Int 2021; 323: 110812
• 12 Lakomek F, Lukas RP, Brinkrolf P. et al. Real-time feedback improves chest compression quality in out-of-hospital cardiac arrest: A prospective cohort study. PLoS One 2020; 15: e0229431
• 13 Stampfl U, Sommer CM, Bellemann N. et al. Emergency embolization for the treatment of acute hemorrhage from intercostal arteries. Emerg Radiol 2014; 21: 565-570
• 14 Chemelli AP, Thauerer M, Wiedermann F. et al. Transcatheter arterial embolization for the management of iatrogenic and blunt traumatic intercostal artery injuries. J Vasc Surg 2009; 49: 1505-1513
• 15 Kessel B, Alfici R, Ashkenazi I. et al. Massive hemothorax caused by intercostal artery bleeding: selective embolization may be an alternative to thoracotomy in selected patients. Thorac Cardiovasc Surg 2004; 52: 234-236
• 16 Krüger K, Radeleff B, Stampfl U. Notfallembolisation. In: Radeleff B. Angiofibel. Berlin, Heidelberg: Springer; 2021.
• 17 Scholz KH, Busch HJ, Frey N. et al. Qualitatskriterien und strukturelle Voraussetzungen fur Cardiac Arrest Zentren – Update 2021. Notf Rett Med 2021;