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Notfallthorakotomie nach hämorrhagischem Schock bei traumatischer pelviner Blutung bei Schwerstverletztem

Fallbericht

Emergency thoracotomy in a severely injured patient after hemorrhagic shock in traumatic pelvic bleeding

Case report

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Zusammenfassung

Es wird über einen Fall einer innerklinisch durchgeführten Thorakotomie mit nachfolgender direkter Reanimation am offenen Brustkorb eines polytraumatisierten Patienten berichtet. Notfallthorakotomien sind seltene Eingriffe in herausfordernden Situationen. Die Indikationsstellung ist oft eine Grenzentscheidung. In Kombination mit einer Kreislaufverkleinerung, beispielsweise durch Abklemmen der Aorta, verfolgt die Thorakotomie mit direkter Herzmassage das Ziel, die Durchblutung in den lebenswichtigen koronaren und zerebralen Kreisläufen aufrechtzuerhalten, Blutverluste aus distal gelegenen Blutungsquellen zu minimieren und reversible Ursachen zu beheben. Letztlich kann die Thorakotomie im Zweifel zum Wohle des Patienten bei entsprechender Indikation durchgeführt werden.

Abstract

A case of in-hospital thoracotomy with subsequent open chest cardiopulmonary resuscitation of a polytraumatized patient is reported. Emergency thoracotomies are rare interventions in challenging situations. Up to now there are only few standards or uniform education and training concepts. The indications are often a borderline decision. The aim of thoracotomy and open resuscitation in combination with a reduction in circulation, for example by cross-clamping the aorta, is to save time to address reversible causes of the hemorrhage, redirect the blood volume into the vital cerebral and coronary circulation and minimize bleeding from subdiaphragmatic bleeding sources. Ultimately, in case of doubt, the thoracotomy can be performed for the patient’s benefit with the appropriate indications.

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Danksagung

Wir danken Herrn Ralf Hettler für die freundliche Überlassung des Bildmaterials.

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Authors and Affiliations

  1. ATORG – Aschaffenburg Trauma and Orthopaedic Research Group, Zentrum für Orthopädie, Unfallchirurgie und Sportmedizin, Klinikum Aschaffenburg-Alzenau gGmbH, Am Hasenkopf 1, 63739 Aschaffenburg, Deutschland

    Tim Friedrich Raven, Lena Welte, Jörn Heepe, Tim Arnold & Arash Moghaddam

  2. Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum der Goethe-Universität Frankfurt, 60590, Frankfurt am Main, Deutschland

    Tim Friedrich Raven

  3. Klinik für Anästhesie und operative Intensivmedizin, Klinikum Aschaffenburg-Alzenau gGmbH, Am Hasenkopf 1, 63739, Aschaffenburg, Deutschland

    Majdi Yousif, Karin Heimberger & York Alexander Zausig

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  1. Tim Friedrich Raven
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Correspondence to Tim Friedrich Raven.

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Interessenkonflikt

T. F. Raven, L. Welte, M. Yousif, J. Heepe, T. Arnold, K. Heimberger, Y. A. Zausig und A. Moghaddam geben an, dass kein Interessenkonflikt besteht. Das Thema wird unabhängig und produktneutral präsentiert.

Die vorliegende Arbeit wurde im Rahmen der Good Clinical Practice gemäß den ethischen Prinzipien durchgeführt, die auf die Deklaration von Helsinki in ihrer aktuellen Form zurückgehen. Die Zustimmung zur Datenauswertung wurde eingeholt und ein Einverständnis wurde hierzu erteilt. Alle Daten wurden anonym archiviert.

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Redaktion

W. Mutschler, München

H. Polzer, München

B. Ockert, München

Dieser Beitrag entstand im Rahmen der Anstellung von T. F. Raven am Klinikum Aschaffenburg-Alzenau gGmbH; der Autor ist jetzt an der Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum der Goethe-Universität, Frankfurt am Main, tätig.

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Raven, T.F., Welte, L., Yousif, M. et al. Notfallthorakotomie nach hämorrhagischem Schock bei traumatischer pelviner Blutung bei Schwerstverletztem. Unfallchirurgie 125, 568–573 (2022). https://doi.org/10.1007/s00113-021-01055-x

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