Der Unfallchirurg

, Volume 110, Issue 10, pp 884–890 | Cite as

Kreislaufstillstand nach stumpfem Thoraxtrauma

Notfallthorakotomie ohne Wenn und Aber?
  • B.A. Leidel
  • K.G. Kanz
  • C. Kirchhoff
  • D. Bürklein
  • A. Wismüller
  • W. Mutschler
In der Diskussion

Zusammenfassung

Schwere Thoraxverletzungen sind im deutschsprachigen Raum meist auf stumpfe Gewalteinwirkung zurückzuführen und stellen beim mehrfachverletzten, polytraumatisierten Patienten nach dem Schädel-Hirn-Trauma die zweithäufigste relevante Verletzungsfolge dar. Nahezu jeder 3. polytraumatisierte Patient mit relevantem Thoraxtrauma entwickelt ein Lungenversagen und jeder 4. ein Kreislaufversagen.

Das akute Kreislaufversagen nach schwerem Thoraxtrauma ist mit einer hohen initialen Letalität behaftet und meist Ausdruck eines Spannungspneumothorax, einer Perikardtamponade oder eines hämorrhagischen Schocks infolge einer Verletzung des Herzens oder der großen herznahen Gefäße. Im Rahmen des Schockraummanagements polytraumatisierter Patienten kommt deshalb neben zügiger Entlastung eines Spannungspneumothorax und ausreichender Volumensubstitution der raschen lebensrettenden Notfallthorakotomie zur direkten offenen Herzmassage, Entlastung des Perikards und Blutungskontrolle eine besondere Bedeutung zu. Trotzdem wird die Überlebenswahrscheinlichkeit von Patienten mit schwerem stumpfen Thoraxtrauma und akutem Kreislaufversagen in der Literatur meist als sehr gering beschrieben.

In der vorliegenden Kasuistik berichten wir über eine polytraumatisierte Patientin, die nach Aufnahme im Schockraum infolge einer Perikardtamponade einen plötzlichen Kreislaufstillstand erlitt und nach Notfallthorakotomie ohne neurologische Defizite überlebte.

Anhand ausgewählter aktueller Publikationen werden dem im Schockraum Behandelnden Entscheidungshilfen zur Indikation und Durchführung der Notfallthorakotomie nach stumpfem Thoraxtrauma gegeben.

Schlüsselwörter

Stumpfes Thoraxtrauma Perikardtamponade Notfallthorakotomie Intensivtransporthubschrauber 

Cardiac arrest following blunt chest injury

Emergency thoracotomy without ifs or buts?

Abstract

In German-speaking countries, most serious thoracic injuries are attributable to the impact of blunt force; they are the second most frequent result of injury after head injury in polytrauma patients with multiple injuries. Almost one in every three polytraumatized patients with significant chest injury develops acute lung failure, and one in every four, acute circulatory failure.

The acute circulatory arrest following serious chest injury involves a high mortality rate, and in most cases it reflects a tension pneumothorax, cardiac tamponade, or hemorrhagic shock resulting from injury to the heart or one of the large vessels close to it. Brisk drainage of tension pneumothorax and adequate volume restoration are therefore particularly important in resuscitation of multiply traumatized patients, as are rapid resuscitative thoracotomy to allow direct heart massage, drainage of pericardial tamponade, and control of hemorrhage. However the probability of survival described in the literature is very low for patients sustaining severe chest trauma with acute cardiac arrest.

The case report presented here describes a female polytrauma patient who suffered an acute cardiac arrest following cardiac tamponade after admission in the emergency department and who survived without neurological deficits after an emergency thoracotomy.

Selections from the topical literature can help the treating physician in the emergency department in making decisions on whether an emergency thoracotomy is indicated after a blunt chest injury and on the procedure itself.

Keywords

Blunt chest trauma Cardiac tamponade Emergency thoracotomy Resuscitative thoracotomy 

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  • B.A. Leidel
    • 1
    • 3
    • 4
  • K.G. Kanz
    • 1
  • C. Kirchhoff
    • 1
  • D. Bürklein
    • 1
  • A. Wismüller
    • 2
  • W. Mutschler
    • 1
  1. 1.Klinikum der Universität MünchenChirurgische Klinik und Poliklinik – InnenstadtMünchenDeutschland
  2. 2.Klinikum der Universität MünchenInstitut für Klinische Radiologie – InnenstadtMünchenDeutschland
  3. 3.Luftrettungszentrum „Christoph München“, HDM Luftrettung, Team DRF, Klinikum der Universität München – GroßhadernMünchenDeutschland
  4. 4.EMQ Helicopter Rescue, Emergency Management Queensland und CareFlight Medical Services QLDCairnsAustralia

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