Beinaheertrinken: Epidemiologie - Pathophysiologie - Therapie

Zusammenfassung

Ertrinkungsunfälle sind häufige und meist vermeidbare Ereignisse, die oft junge gesunde Menschen betreffen, und mit erheblicher Morbidität und Mortalität einhergehen. Während der Begriff „Ertrinken” den Tod durch Einatmen von Flüssigkeiten bezeichnet, versteht man unter „Beinaheertrinken”, unabhängig vom Vorhandensein einer Flüssigkeitsaspiration, einen Ertrinkungsunfall der zumindest für 24 Stunden überlebt wird. Beinaheertrinken geht mit komplexen pathophysiologischen Störungen einher, die alle Organsysteme betreffen können. Bei der Mehrzahl der Patienten führt Flüssigkeitsaspiration zu einem rasch auftretenden, schweren Lungenversagen mit generalisierter Hypoxie und Sekundärschädigung aller anderen Organsysteme. Entscheidend für die Prognose des Patienten sind letztlich die Schäden am Zentralnervensystem. Aus diesem Grund stellt bereits am Notfallort die sofortige Unterbrechung von Hypoxie und Wiederherstellung stabiler Kreislaufverhältnisse wichtigstes Ziel der Behandlung beinaheertrunkener Patienten dar. Leider gibt es keine zuverlässigen Prognosekriterien, die bereits in der Initialphase der Erkrankung verlässlich Auskunft über das weitere Schicksal des Patienten geben könnten. Zudem zeigen zahlreiche Untersuchungen, dass die Prognose Beinaheertrunkener selbst bei längerer Asphyxie vor allem in kalten Gewässern durchaus gut sein kann. Aus diesem Grund ist ein aggressives therapeutisches Vorgehen mit Einsatz aller zur Verfügung stehenden Techniken bei Beinaheertrunkenen in den meisten Fällen gerechtfertigt.

Abstract

Near-drowning is a frequent preventable accident with a significant morbidity and mortality in a previous healthy population. In most patients the primary injury is pulmonary failure due to fluid aspiration, resulting in severe arterial hypoxemia and secondary damage to other organs. Immediate interruption of hypoxia is of utmost importance in the emergency situation. Accurate neurologic prognosis cannot be predicted from initial clinical presentation, laboratory, radiological or electrophysiological examinations. Prompt resuscitation and aggressive respiratory and cardiovascular treatment are crucial for optimal survival. This review provides the reader with detailed information on epidemiology, pathophysiology, emergency decision making and general treatment in near drowning accidents.

Schlüsselwörter

Beinaheertrinken - Ertrinkungsunfall - ARDS - Notfalltherapie - Intensivtherapie

Key words

Near-drowning - drowning - ARDS - emergency treatment - intensive care treatment

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