Notfallmedizin up2date 2015; 10(02): 185-208
DOI: 10.1055/s-0033-1358144
Rettungsdienst
Georg Thieme Verlag KG Stuttgart · New York

Handlungsempfehlung zur prähospitalen Notfallnarkose beim Erwachsenen[1],[2]

Arbeitsgruppe „Prähospitale Notfallnarkose“ des Wissenschaftlichen Arbeitskreises Notfallmedizin der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin,
M. Bernhard
,
B. Bein
,
B. W. Böttiger
,
A. Bohn
,
M. Fischer
,
J. T. Gräsner
,
J. Hinkelbein
,
C. Kill
,
C. Lott
,
E. Popp
,
M. Roessler
,
A. Schaumberg
,
V. Wenzel
,
B. Hossfeld
Further Information

Publication History

Publication Date:
14 July 2015 (online)

Abkürzungen

ACH: Acetylcholin
ARDS: Acute respiratory Distress Syndrome
BMI: Body-Mass-Index
BURP: Backward-upward-rightward Pressure
COPD: chronisch obstruktive Lungenerkrankung
CPAP: Continuous positive Airway Pressure
DGAI: Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin
DIVI: Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin
etCO2 : endtidales Kohlenstoffdioxid
GABA: Gamma-Amino-Buttersäure
GSC: Glasgow Coma Scale
HR: Herzfrequenz
HWS: Halswirbelsäule
ICP: intrazerebraler Druck
MILS: manuelle Inline-Stabilisierung (der Wirbelsäule)
NIV: nichtinvasive Beatmung
NMDA: N-Methyl-D-Aspartat
SGA: supraglottischer Atemweg
SHT: Schädel-Hirn-Trauma
SOP: Standard Operating Procedure
SpO2 : Sauerstoffsättigung (pulsoxymetrisch gemessen)

1 Beschluss des Engeren Präsidiums der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) vom 12. 03. 2015 in Berlin.


2 Erstveröffentlichung in: Anästh Intensivmed 2015; 56: 317–335


 
  • Literatur

  • 1 Adams HP, Adams RJ, Brott T et al. Guidelines for the early management of patients with ischemic stroke: A scientific statement from the Stroke Council of the American Stroke Association. Stroke 2003; 34: 1056-1083
  • 2 Barnard EB, Moy RJ, Kehoe AD et al. Rapid sequence induction of anaesthesia via the intraosseous route: a prospective observational study. Emerg Med J 2015; 32: 449-452
  • 3 Benumof JL, Dagg R, Benumof R. Critical hemoglobin desaturation will occur before return to an unparalayzed state following 1 mg/kg intravenous succinylcholine. Anesthesiology 1997; 87: 979-982
  • 4 Bergen J, Smith D. A review of etomidate for rapid sequence intubation in the emergency department. J Emerg Med 1997; 15: 221-223
  • 5 Bernhard M, Beres W, Timmermann A et al. Prehospital airway management using the laryngeal tube. An emergency department point of view. Anaesthesist 2014; 63: 589-596
  • 6 Bernhard M, Gräsner JT, Gries A et al. Die intraossäre Infusion in der Notfallmedizin. Erste deutsche Empfehlung der DGAI-Arbeitskreise. Anästh Intensivmed 2010; 51 (Suppl) S615-S620
  • 7 Bernhard M, Helm M, Luiz T et al. Pädiatrische Notfälle in der prähospitalen Notfallmedizin. Notfall Rettungsmed 2011; 14: 554-566
  • 8 Bernhard M, Hilger T, Sikinger M et al. Patientenspektrum im Notarztdienst. Anaesthesist 2006; 33: 1157-1165
  • 9 Brain Trauma Foundation. Guidelines for the management of severe traumatic brain injury. 1. Blood Pressure and Oxygenation. J Neurotrauma 2007; 24 (Suppl. 01) S7-S13
  • 10 Braun P, Wenzel V, Paal P. Anaesthesia in prehospital emergencies and in the emergency department. Curr Opin Anesthesiol 2010; 23: 500-506
  • 11 Breckwoldt J, Kleimstein S, Brunne B et al. Expertise in prehospital endotracheal intubation by emergency physicians. Comparing “proficient performer” and “experts”. Resuscitation 2012; 83: 434-439
  • 12 Bretschneider I, Hossfeld B, Helm M et al. Präklinisches Atemwegsmanagement beim Erwachsenen. Notarzt 2011; 27: 270-286
  • 13 Cavus E, Callies A, Doerges V et al. The C-MAC videolaryngoscope for prehospital emergency intubation: a prospective, multicentre, observational study. Emerg Med 2011; 28: 650-653
  • 14 Chan C, Mitchell A, Shorr A. Etomidate is associated with mortality and adrenal insufficiency in sepsis: a meta-analysis. Crit Care Med 2012; 40: 2945-2953
  • 15 Chi JH, Knudson MM, Vassar MJ et al. Prehospital hypoxia affects outcome in patients with traumatic brain injury: a prospective multicenter study. J Trauma 2006; 61: 1134-1141
  • 16 Christ M, Popp S, Erbguth E. Algorithmen zur Abklärung von Bewusstseinsstörungen in der Notaufnahme. Intensivmed 2010; 47: 83-93
  • 17 Cook T, Behringer EC, Benger J. Airway management outside the operating room: hazardous and incompletely studied. Curr Opin Anaesthesiol 2012; 25: 461-469
  • 18 Connor CW, Segal S. The importance of subjective facial appearance on the ability of anesthesiologists to predict difficult intubations. Anesth Analg 2014; 118: 419-427
  • 19 Cotton BA, Guillamondegui OD, Fleming SB. Increases risk of adrenal insufficiency following etomidate exposure in critically injured patients. Arch Surg 2008; 143: 62-67
  • 20 Cowan GM, Burton F, Newton A. Prehospital anaesthesia: a survey of the current practice in the UK. Emerg Med J 2012; 29: 136-140
  • 21 DIVI-Empfehlungen zur Kennzeichnung von Spritzen in der Intensiv- und Notfallmedizin 2012. Im Internet: http://www.divi.de/images/Dokumente/Empfehlungen/Spritzenetiketten/DIVI-Etiketten-Empfehlung_2012_07_02.pdf Stand: 12.02.2015
  • 22 Easby J, Dodds C. Emergency induction of anaesthesia in the prehospital setting: a review of the anaesthetic induction agents. J Trauma 2004; 6: 217-224
  • 23 Edlow JA, Rabinstein A, Traub SJ et al. Diagnosis of reversible causes of coma. Lancet 2014; 384: 2064-2076
  • 24 Eich C, Roessler M, Nemeth M et al. Characteristics and outcome of prehospital pediatric tracheal intubation attended by anaesthesia-training emergency physicians. Resuscitation 2009; 80: 1371-1377
  • 25 El-Beheiry H, Kim J, Milne B. Prophylaxis against the systemic hypotension iduced by propofol during rapid-sequence intubation. Can J Anaesth 1995; 42: 875-878
  • 26 El-Orbany M, Connolly LA. Rapid sequence induction and intubation: current controvery. Anesth Analg 2010; 110: 1318-1325
  • 27 European Stroke Organisation (ESO) Executive Committee, ESO Writing Committee (2008). Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis (Basel, Switzerland) 2008; 25: 457-507
  • 28 Genzwürker HV, Finteis T, Wegener S et al. Inzidenz der endotrachealen Intubation im Notarztdienst: adäquate Erfahrung ohne klinische Routine kaum möglich. Anästh Intensivmed 2010; 4: 202-210
  • 29 Gräsner JT, Heller G, Dörges V et al. Narkose im Rettungsdienst. Notfallmedizin up2date 2007; 2: 197-202
  • 30 Gries A, Zink W, Bernhard M et al. Realistic assessment of the physician-staffed emergency services in Germany. Anaesthesist 2006; 55: 1080-1086
  • 31 Hasler RM, Nuesch E, Jüni P et al. Systolic blood pressure below 110 mmHg is associated with increased mortality in blunt major trauma patients: multicenter cohort study. Resuscitation 2012; 83: 476-481
  • 32 Helm M, Biehn G, Lampl L et al. Pädiatrischer Notfallpatient im Luftrettungsdienst. Anaesthesist 2010; 59: 896-903
  • 33 Helm M, Gries A, Mutzbauer T. Surgical approach in difficult airway management. Best Practice Res Clin Anaesth 2005; 19: 623-640
  • 34 Helm M, Hossfeld B, Schäfer S et al. Factors influencing emergency intubation in the pre-hospital setting – a multicentre study in the German Helicopter Emergency Medical Service. Br J Anaesth 2006; 96: 67-71
  • 35 Helm M, Kremers G, Lampl L et al. Incidence of transient hypoxia during pre-hospital rapid sequence intubation by anaesthesiologists. Acta Anaesthesiol Scand 2013; 57: 199-205
  • 36 Henderson JJ, Popat MT, Latto IP et al. Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia 2004; 59: 675-694
  • 37 Herff H, Wenzel V, Lockey D. Prehospital Intubation: The right tools in the right hands at the right time. Anesth Analg 2009; 109: 303-305
  • 38 Heuer JF, Barwing TA, Barwing J et al. Incidence of difficult intubation in intensive care patients: Analysis of contributing factors. Anaesth Intensive Care 2012; 40: 120-127
  • 39 Hossfeld B, Lampl L, Helm M. Notwendigkeit eines Algorithmus für den „schwierigen Atemweg“ in der Präklinik. Notfall Rettungsmed 2011; 14: 10-14
  • 40 Hossfeld B, Maier B, Kuhnigk H et al. Narkose im Notarztdienst. Notfall Rettungsmed 2011; 14: 15-20
  • 41 Hugg CJ, McLeskey C, Nahrwold M. Haemodynamic effects of propofol: data from over 25.000 patientes. Anesth Analg 1993; 77 (Suppl) 21-29
  • 42 Hedenstierna G, Edmark L. The effects of anesthesia and muscle paralysis on the respiratory system. Intensive Care Med 2005; 31: 1327-1335
  • 43 Innerklinische Akutversorgung des Patienten mit Schädel-Hirn-Trauma. Aktualisierte Empfehlungen des Wissenschaftlichen Arbeitskreis Neuroanästhesie der DGAI. Anästh Intensivmed 2009; 50: S489-S501
  • 44 Jabre P, Combes X, Lapostolle F et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet 2009; 374: 293-300
  • 45 Jacoby J, Heller M, Nicholas J et al. Etomidate versus midazolam for out-of-hospital intubation: aprospective, randomized trial. Ann Emerg Med 2006; 47: 525-530
  • 46 Kheterpal S, Healy D, Aziz MF et al. Incidence, predictors, and outcome of difficult mask ventilation combined with difficult laryngoscopy: a report from the multicenter perioperative outcomes group. Anesthesiology 2013; 119: 1360-1369
  • 47 Koenig SJ, Lakticova V, Narasimhan M et al. Safety of propofol as an induction agent for urgent endotracheal intubation in the medical intensive care unit. J Intensive Care Med 2014; [Epub ahead of print]
  • 48 Kuhnigk H, Zischler K, Roewer N. Narkose in der Notfallmedizin. Stuttgart: Thieme; 2007
  • 49 Liccardia G, Salzilloa A, De Blasiob F et al. Control of asthma for reducing the risk of bronchospasm in asthmatics undergoing general anesthesia and/or intravascular administration of radiographic contrast media. Curr Med Res Opin 2009; 25: 1621-1630
  • 50 Lockey D, Carter J, Nolan J et al. AAGBI Safety Guideline. Pre-hospital anaesthesia. (2009). Im Internet: http://www.aagbi.org/publications/guidelines/docs/prehospital_glossy09.pdf Stand: Februar 2009
  • 51 Lossius HM, Roislien J, Lockey DJ. Patient safety in pre-hospital emergency tracheal intubation: a comprehensive meta-analysis of the intubation success rates of EMS providers. Crit Care 2012; 16: R24
  • 52 Luxen J, Trentzsch H, Urban B. Rocuronium und Sugammadex in der Notfallmedizin. Anaesthesist 2014; 63: 331-337
  • 53 Mayglothling J, Duane TM, Gibbs M et al. Emergency tracheal intubation immediately following traumatic injury: An Eastern association for the surgery of trauma practice management guideline. J Trauma Acute Care Surg 2012; 73: S333-S340
  • 54 Messelken M, Kehrberger E, Dirks B et al. The quality of emergency medical care in Baden-Württemberg (Germany): four years in focus. Dtsch Arztebl Int 2010; 107: 523-530
  • 55 Moulton C, Pennycook AG. Relation between Glasgow coma score and cough reflex. Lancet 1994; 343: 1261-1262
  • 56 Mrugalla HR, Samberger M, Schuhmann W et al. Übergabemanagement fu¨r Beatmungspatienten im Luftrettungsdienst. Ergebnisse einer bundesweiten Umfrage. Notfall Rettungsmed 2003; 6: 233-241
  • 57 Neumayr A, Ganster A, Schinnerl A et al. Unterschätzte Gefahr am Notfallort. Plädoyer zur Einführung von Risikomanagement. Notfall Rettungsmed 2014; 17: 25-31
  • 58 Newton A, Ratchford A, Khan I. Incidence of adverse events during prehospital rapid sequence intubation: A review of one year on the London helicopter emergency medical service. J Trauma 2008; 64: 487-492
  • 59 Niven AS, Doerschug KC. Techniques for the difficult airway. Curr Opin Crit Care 2013; 19: 9-15
  • 60 Rognås L, Hansen TM, Kirkegaard H et al. Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study. Scand J Trauma Resusc Emerg Med 2013; 21: 58
  • 61 Paal P, Herff H, Mitterlechner T et al. Anaesthesia in prehospital emergencies and in the emergency room. Resuscitation 2010; 81: 148-154
  • 62 Patanwala AE, McKinney CB, Erstad BL et al. Retrospective analysis of etomidate versus ketamine for first-pass-success in an academic emergency department. Acad Emerg Med 2014; 21: 87-91
  • 63 Pehböck D, Wenzel V, Voelckel W et al. Effects of preoxygenation on desaturation time during hemorrhagic shock in pigs. Anesthesiology 2010; 113: 593-599
  • 64 Perry JJ, Lee JS, Sillberg VA et al. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev 2008; (2) CD002788
  • 65 Reinhart K, Brunkhorst FM, Bone HG et al. Prävention, Diagnose, Therapie und Nachsorge der Sepsis. Erste Revision der S2 k-Leitlinie der Deutschen Sepsis-Gesellschaft e.V. (DSG) und der Deutschen Interdisziplinären Vereinigung für Intensivmedizin und Notfallmedizin (DIVI). Anaesthesist 2010; 59: 347-370
  • 66 Rognås L, Hansen TM, Kirkegaard H, Tønnesen E. Anaesthesiologist-provided prehospital airway management in patients with traumatic brain injury: an observational study. Eur J Emerg Med 2014; 21: 418-423
  • 67 Rortgen D, Schaumberg A, Skorning M et al. Stocked medications in emergency physician-based medical services in Germany. Reality and requirements according to guidelines. Anaesthesist 2011; 60: 312-324
  • 68 Sakles JC, Chiu S, Mosier J et al. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med 2013; 20: 71-78
  • 69 Schlechtriemen T, Reeb R, Ensle G et al. Überprüfung der korrekten Tubuslage in der Notfallmedizin. Notfall Rettungsmed 2004; 7: 231-236
  • 70 Schmidt J, Strauß JM, Becke K et al. Handlungsempfehlung zur Rapid-Sequence-Induction im Kindesalter. Anästh Intensivmed 2007; 48: S88-S93
  • 71 Sefrin P, Kuhnigk H, Wurmb T. Narkose im Rettungsdienst. Notarzt 2014; 30: 73-84
  • 72 Sitzwohl C, Langheinrich A, Schober A et al. Endobronchial intubation detected by insertion depth of endotracheal tube, bilateral auscultation, or observation of chest movements: randomised trial. BMJ 2010; 341: c5943
  • 73 Sørensen MK, Bretlau C, Gätke MR et al. Rapid sequence induction and intubation with rocuronium-sugammadex compared with succinylcholine: a randomized trial. Br J Anaesth 2012; 108: 682-689
  • 74 S3-Leitlinie Polytrauma/Schwerverletztenbehandlung. AWMF-Register Nr.: 012/019. Im Internet: http://www.awmf.org/uploads/tx_szleitlinien/012-019l_S3_Polytrauma_Schwerverletzten-Behandlung_2015-01.pdf Stand: 12.02.2015
  • 75 Steinmann D, Priebe HJ. Krikoiddruck. Anaesthesist 2009; 58: 695-707
  • 76 Stollings JL, Diedrich DA, Oyen LJ et al. Rapid-sequence intubation: a review of the process and considerations when choosing medications. Ann Pharmacother 2014; 48: 62-76
  • 77 Swanson ER, Fosnocht DE, Jensen SC. Comparison of etomidate and midazolam for prehospital rapid-sequence intubation. Prehosp Emerg Care 2004; 8: 273-279
  • 78 Thierbach A, Piepho T, Wolcke B et al. Präklinische Sicherung der Atemwege – Erfolgsraten und Komplikationen. Anaesthesist 2004; 53: 543-550
  • 79 Timmermann A, Byhahn C, Wenzel V et al. Handlungsempfehlungen für das präklinische Atemwegsmanagement. Anaesth Intensivmed 2012; 53: 294-308
  • 80 Timmermann A, Byhahn C. Krikoiddruck. Schützender Handgriff oder etablierter Unfug. Anaesthesist 2009; 58: 663-664
  • 81 Van den Heuvel I, Wurmb TE, Böttiger BW et al. Pros and cons of etomidate—more discussion than evidence?. Curr Opin Anaesthesiol 2013; 26: 404-408
  • 82 Van der Walt J. Anaesthesia in children with viral respiratory tract infections. Paediatr Anaesth 1995; 5: 257-262
  • 83 Voelckel WG, von Goedecke A, Fries D et al. Die Behandlung des hämorrhagischen Schocks. Neue Therapieoptionen. Anaesthesist 2004; 53: 1151-1167
  • 84 Von Goedecke A, Herff A, Paal P et al. Field airway management disasters. Anesth Analg 2007; 104: 481-483
  • 85 Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med 2012; 59: 165-175.e1
  • 86 Weller D, Domke A, Gahn G. Management des refraktären Status epilepticus mit Propofol. Akt Neurologie 2006; 33: P532
  • 87 Werdan K, Ruß M, Buerke M et al. Deutsch-österreichische S3-Leitlinie „Infarktbedingter kardiogener Schock – Diagnose, Monitoring und Therapie. Kardiologe 2011; 5: 1666-1224
  • 88 Wetsch WA, Carlitscheck M, Spelten O et al. Success rates and endotracheal tube insertion times of experienced emergency physicians using five video laryngoscopes: a randomised trial in a simulated trapped car accident victim. Eur J Anaesthesiol 2011; 28: 849-858
  • 89 Wetsch WA, Hellmich M, Spelten O et al. Endotracheal intubation in ice-pick position with video laryngoscopes – a randomised controlled trial in a manikin. Eur J Anaesthesiol 2013; 30: 537-543
  • 90 Wilbur K, Zed PJ. Is propofol an optimal agent for procedural sedation and rapid sequence intubation in the emergency department?. CJEM 2001; 3: 302-310
  • 91 Zollinger A, Hofer CK, Kuhnle G, Schwender D, Schnoor J. Anästhesie bei Patienten mit Lungenerkrankungen. In: Rossaint R, Werner C, Zwißler B, Hrsg. Die Anästhesiologie. 3. Aufl. Berlin, Heidelberg, New York: Springer; 2012