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Der Anaesthesist

, Volume 67, Issue 4, pp 280–292 | Cite as

„Resuscitative endovascular balloon occlusion of the aorta“

Option für nichtkomprimierbare Körperstammblutungen?
  • J. Knapp
  • M. Bernhard
  • T. Haltmeier
  • D. Bieler
  • B. Hossfeld
  • M. Kulla
Notfallmedizin

Zusammenfassung

Verbluten ist beim Traumapatienten die häufigste vermeidbare Todesursache. Dabei finden sich im zivilen Rettungsdienst in Europa lebensbedrohliche Blutungen meist in nichtkomprimierbaren Körperregionen wie dem Abdomen oder dem Becken. Zur raschen Kontrolle von schwersten Blutungen in diesen Bereichen wird daher in letzter Zeit das v. a. im Bereich der Gefäßchirurgie etablierte Verfahren der aortalen Ballonokklusion auch für die notfallmäßige Versorgung von Traumapatienten propagiert.

Im vorliegenden Artikel wird zum einen eine umfassende Übersicht über die Technik, mögliche Indikationen, Kontraindikationen und Komplikationen der notfallmäßigen endovaskulären Ballonokklusion der Aorta („resuscitative endovascular balloon occlusion of the aorta“, REBOA) geboten. Zum anderen werden die bisher berichteten Behandlungsergebnisse aus der verfügbaren Literatur zusammengefasst und diskutiert, um hieraus mögliche praxisrelevante Konsequenzen für die zukünftige Etablierung der REBOA im Bereich der Notfallmedizin abzuleiten.

Schlüsselwörter

Trauma Schockraumversorgung REBOA Notfallmäßige endovaskuläre Ballonokklusion der Aorta Blutung Blutungstherapie 

Resuscitative endovascular balloon occlusion of the aorta

Option for incompressible trunk bleeding?

Abstract

Hemorrhage is the single largest cause of avoidable death in trauma patients, whereby in civil emergency medicine in Europe most life-threatening hemorrhages occur in the abdomen and the pelvis. This is one reason why endovascular balloon occlusion of the aorta (EBOA), a procedure especially established in vascular surgery, is increasingly propagated for rapid bleeding control in these patients. This review article provides a comprehensive overview of the technique, indications, contraindications and complications of resuscitative endovascular balloon occlusion of the aorta (REBOA). Additionally, outcomes reported in in the currently available literature are summarized and discussed. From this practical and user-oriented consequences for future successful introduction of REBOA in the field of emergency medicine are deduced.

Keywords

Trauma Emergency trauma room REBOA Resuscitative endovascular balloon occlusion of the aorta Bleeding Bleeding management 

Notes

Danksagung

Ein herzlicher Dank an Prytime Medical Boerne, Texas, USA, für die kostenlose Freigabe der Abb. 1a und 2 sowie an Medtronic Santa Rosa, Kalifornien, USA, für die kostenlose Freigabe der Abb. 1b.

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Knapp, M. Bernhard, T. Haltmeier, D. Bieler, B. Hossfeld und M. Kulla geben an, keine Interessenkonflikte im Rahmen der vorgelegten Publikation zu haben. M. Kulla gibt an, Fördermittel vom Bundesministerium der Verteidigung (FKZ 34K3-17 1515 Digipen und 37K3-S-20 1616 Patientenzufriedenheit mit der Behandlung in einer zentralen Notaufnahme) und weitere Fördermittel vom BMBF (Verbundprojekt: AKTIN Verbesserung der Versorgungsforschung in der Akutmedizin durch den Aufbau eines nationalen Notaufnahmeregisters) sowie „ENQuIRE – Evaluierung der Qualitätsindikatoren von Notaufnahmen auf Outcome-Relevanz für den Patienten“ (VSF1_2017-020) außerhalb der eingereichten Arbeit erhalten zu haben.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • J. Knapp
    • 1
  • M. Bernhard
    • 2
  • T. Haltmeier
    • 3
  • D. Bieler
    • 4
  • B. Hossfeld
    • 5
  • M. Kulla
    • 5
  1. 1.Universitätsklinik für Anästhesiologie und SchmerztherapieUniversitätsspital BernBernSchweiz
  2. 2.Zentrale NotaufnahmeUniversitätsklinikum LeipzigLeipzigDeutschland
  3. 3.Universitätsklinik für Viszerale Chirurgie und MedizinUniversitätsspital BernBernSchweiz
  4. 4.Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs- und Handchirurgie, VerbrennungsmedizinBundeswehrzentralkrankenhaus KoblenzKoblenzDeutschland
  5. 5.Klinik für Anästhesiologie und Intensivmedizin/Sektion NotfallmedizinBundeswehrkrankenhaus UlmUlmDeutschland

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