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Management der Gerinnungsstörung bei traumainduzierter Hypovolämie und (un-)kontrollierter Blutung

Management of coagulation disorders in trauma-linked hypovolemia and (un)controlled bleeding

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Zusammenfassung

Nach dem Bericht „Global burden of disease“ 2004 der Weltgesundheitsorganisation sind etwa 10% aller Todesfälle auf ein Trauma zurückzuführen. Da insbesondere junge Menschen zwischen dem 15. und 45. Lebensjahr betroffen sind, stellt das Trauma als Todesursache ein erhebliches soziales und gesundheitsökonomisches Problem dar. Unkontrollierbare Massenblutungen, die durch Gewebsverletzungen und das Vorliegen von Gerinnungsstörungen verursacht werden, sind in bis zu 40% die Ursache für die hohe Letalität. Die Therapie manifester Koagulopathien erfolgt überwiegend nach empirischen Therapiealgorithmen mit hämostatisch wirksamen Blutprodukten. Allerdings ist die Transfusion von Erythrozyten- und Thrombozytenkonzentraten sowie Frischplasma komplikationsbehaftet (postoperative Infektionen, Multiorganversagen u. a.). Die Minimierung des Transfusionsbedarfs und die zügige Wiederherstellung des hämostatischen Gleichgewichts erfordert daher eine klare und interdisziplinäre Strategie.

Abstract

According to the global study of the burden of disease 2004 by the World Health Organisation, trauma accounts for 10% of deaths worldwide and the majority of victims are between 15 and 44 years of age. The disproportionate number of young people is a considerable burden to society in terms of lost productivity and manpower. Approximately 40% of trauma-related deaths are attributed to or due to exsanguination which is caused by tissue damage and coagulopathy. To terminate coagulopathy-related bleeding empiric algorithms are instituted to replace blood components. The transfusion of red blood cells, thrombocytes and fresh frozen plasma has been shown to be associated with complications, such as post-injury infection and multiple organ failure. To keep the need for transfusion to a minimum and to prevent coagulopathy, the treatment of massive bleeding requires a clear and interdisciplinary strategy to restore haemostatic equilibrium.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Im Rahmen experimenteller Studien wurde dem korrespondierenden Autor rFVIIa (NovoSeven®) von der Firma Novo Nordisk und Fibrinogen (Haemocomplettan®) von der Firma CSL Behring zur Verfügung gestellt. Der Koautor erhielt von den Firmen CSL Behring, Novo Nordisk und Bayer Honorare für Vorlesungen und Beratertätigkeiten. Beide Autoren versichern, dass die Präsentation des Themas unabhängig ist und die Darstellung der Inhalte produktneutral.

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  1. Klinik für Anästhesiologie, Institut für Versuchstierkunde sowie Zentrallaboratorium für Versuchstiere, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    O. Grottke MPH

  2. Klinik für Anästhesiologie, Universitätsklinikum Aachen, Aachen, Deutschland

    R. Rossaint

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  1. O. Grottke MPH
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  2. R. Rossaint
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Correspondence to O. Grottke MPH.

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Grottke, O., Rossaint, R. Management der Gerinnungsstörung bei traumainduzierter Hypovolämie und (un-)kontrollierter Blutung. Notfall Rettungsmed 12, 181–187 (2009). https://doi.org/10.1007/s10049-008-1144-3

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