Skip to main content
SpringerLink
Log in

Invasive Notfalltechniken – INTECH Advanced

REBOA, Perikardiozentese und Clamshell-Thorakotomie

Invasive emergency techniques—INTECH Advanced

REBOA, pericardiocentesis and clamshell thoracotomy

  • Leitthema
  • Published:
Notfall + Rettungsmedizin Aims and scope Submit manuscript

Zusammenfassung

Invasive Notfalltechniken können in bestimmten Situationen lebensrettend sein, sind allerdings selten indiziert, sodass seitens des Rettungsdienst- bzw. Klinikpersonals keine Erfahrung besteht. Entsprechend wird gefordert, diese Maßnahmen in praxisnahen Kurssystemen zu vermitteln und zu trainieren, um sie in der Notfallsituation adäquat anwenden zu können. Beim Heidelberger Kurskonzept INTECH Advanced stehen die invasiven Notfalltechniken „resuscitative endovascular balloon occlusion of the aorta“ (REBOA), Perikardiozentese und Clamshell-Thorakotomie im Mittelpunkt. Diese Verfahren haben kürzlich Eingang in die entsprechenden nationalen und internationalen Leitlinien gefunden. Bei der REBOA wird ein Ballonkatheter über die Leistenarterie eingeführt, in der Aorta descendens platziert und dort geblockt. So kann einerseits der proximale Aortendruck erhöht werden, was eine verbesserte Versorgung von Herz, Lunge und Gehirn bedingt. Andererseits lassen sich distal gelegene Blutungen reduzieren bzw. ausschalten. Die sonographiegesteuerte Perikardiozentese dient der Entlastung von hämodynamisch relevanten serösen Perikardtamponaden, um den Patienten zu stabilisieren und die Zeit bis zur operativen Versorgung zu überbrücken. Traumatisch bedingte, blutige Perikardtamponaden sind hingegen eine Domäne der Notfallthorakotomie. Hier stellt die Clamshell-Thorakotomie eine relativ einfach zu erlernende Methode dar, die eine gute Übersicht bietet und eine Vielzahl an Interventionen erlaubt. Im Vordergrund stehen die offene Entlastung einer blutigen Perikardtamponade sowie die manuelle Kompression der Aorta descendens mit den oben genannten Effekten.

Abstract

Invasive emergency techniques can be a life-saving factor in specific critical situations but because they are rarely utilized, emergency service and hospital personnel lack experience in performing these procedures. It is therefore required to train medical staff in practice-oriented educational courses in order to be able to adequately apply them in life-threatening situations. The Heidelberg course concept INTECH Advanced focuses on the invasive emergency techniques resuscitative endovascular balloon occlusion of the aorta (REBOA), ultrasound-guided pericardiocentesis and clamshell thoracotomy, which were recently introduced into national and international guidelines. In REBOA a balloon catheter is inserted via the femoral artery and inflated in the descending aorta. In doing so the proximal aortic pressure is increased, which results in a better supply for the heart, lungs and brain. In addition, more distally located bleeding can be reduced or even stopped. The primary function of ultrasound-guided pericardiocentesis is the relief of hemodynamically relevant serous pericardial tamponade in order to stabilize the patient and to bridge the time until definitive operative treatment; however, traumatic hemorrhagic pericardial tamponades are the domain of emergency thoracotomy. In this case the clamshell thoracotomy represents a technique that can be easily learnt, provides a good overview and enables a variety of interventions. The main goal is to relieve a hemorrhagic pericardial tamponade and manual compression of the aorta with the abovementioned effects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Truhlar A et al (2015) European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 95:148–201

    Article  Google Scholar 

  2. Deutsche Gesellschaft für Unfallchirurgie (2016) S3 – Leitlinie Polytrauma/Schwerverletztenbehandlung; AWMF-Register Nr.: 012/019. http://www.awmf.org/uploads/tx_szleitlinien/012-019l_S3_Polytrauma_Schwerverletzten-Behandlung_2017-08.pdf. Zugegriffen: 15.05.2018

    Google Scholar 

  3. Truhlář A, Deakin CD, Soar J et al (2015) Kreislaufstillstand unter besonderen Umständen. Kapitel 4 der Leitlinien zur Reanimation 2015 des European Resuscitation Council. Notfall Rettungsmed. https://doi.org/10.1007/s10049-015-0096-7

    Article  Google Scholar 

  4. Bernhard M, Helm M, Mutzbauer T et al (2010) Invasive Notfalltechniken. Notfall Rettungsmed 13:399. https://doi.org/10.1007/s10049-010-1325-8

    Article  Google Scholar 

  5. Holcomb JB et al (2014) Current opinion on catheter-based hemorrhage control in trauma patients. J Trauma Acute Care Surg 76(3):888–893

    Article  Google Scholar 

  6. Hughes CW (1954) Use of an intra-aortic balloon catheter tamponade for controlling intra-abdominal hemorrhage in man. Surgery 36(1):65–68

    CAS  PubMed  Google Scholar 

  7. Sadek S et al (2016) Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the pre-hospital setting: an additional resuscitation option for uncontrolled catastrophic haemorrhage. Resuscitation 107:135–138

    Article  Google Scholar 

  8. Andres J, Scott J, Giannoudis PV (2016) Resuscitative endovascular balloon occlusion of the aorta (REBOA): what have we learned? Injury 47(12):2603–2605

    Article  Google Scholar 

  9. Chaudery M et al (2015) Traumatic intra-abdominal hemorrhage control: has current technology tipped the balance toward a role for prehospital intervention? J Trauma Acute Care Surg 78(1):153–163

    Article  Google Scholar 

  10. Qasim Z et al (2015) Resuscitative endovascular balloon occlusion of the aorta. Resuscitation 96:275–279

    Article  Google Scholar 

  11. Johnson MA et al (2016) Partial resuscitative balloon occlusion of the aorta (P-REBOA): Clinical technique and rationale. J Trauma Acute Care Surg 81(5 Suppl 2):S133–S137 (Proceedings of the 2015 Military Health System Research Symposium)

    Article  Google Scholar 

  12. Saito N et al (2015) Evaluation of the safety and feasibility of resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg 78(5):897–903 (discussion 904)

    Article  Google Scholar 

  13. Tillmann BN (2010) Atlas der Anatomie des Menschen. Springer, Berlin, Heidelberg

    Book  Google Scholar 

  14. Napolitano LM (2017) Resuscitative endovascular balloon occlusion of the aorta: indications, outcomes, and training. Crit Care Clin 33(1):55–70

    Article  Google Scholar 

  15. Rossaint R et al (2016) The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care 20:100

    Article  Google Scholar 

  16. Biffl WL, Fox CJ, Moore EE (2015) The role of REBOA in the control of exsanguinating torso hemorrhage. J Trauma Acute Care Surg 78(5):1054–1058

    Article  Google Scholar 

  17. Russo RM et al (2016) Emerging endovascular therapies for non-compressible torso hemorrhage. Shock 46(3 Suppl 1):12–19

    Article  CAS  Google Scholar 

  18. Regionstrauma TraumaMedEd. 07.09.2017; Available from: http://www.regionstrauma.org/blogs/2016-03TraumaMedEd.pdf.

  19. DuBose JJ et al (2016) The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry: Data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA). J Trauma Acute Care Surg 81(3):409–419

    Article  Google Scholar 

  20. Stannard A, Eliason JL, Rasmussen TE (2011) Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. J Trauma 71(6):1869–1872

    PubMed  Google Scholar 

  21. Chaudery M et al (2016) Can contrast-enhanced ultrasonography improve Zone III REBOA placement for prehospital care? J Trauma Acute Care Surg 80(1):89–94

    Article  Google Scholar 

  22. Delamare L et al (2015) Treatment of intra-abdominal haemorrhagic shock by Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). Anaesth Crit Care Pain Med 34(1):53–55

    Article  Google Scholar 

  23. Uchino H et al (2016) “REBOA” – is it really safe? A case with massive iIntracranial hemorrhage possibly due to endovascular balloon occlusion of the aorta (REBOA). Am J Case Rep 17:810–813

    Article  Google Scholar 

  24. Tsang TS et al (2000) Diagnostic value of echocardiography in cardiac tamponade. Herz 25(8):734–740

    Article  CAS  Google Scholar 

  25. Hunt PA, Greaves I, Owens WA (2006) Emergency thoracotomy in thoracic trauma – a review. Injury 37(1):1–19

    Article  CAS  Google Scholar 

  26. Hagendorff A, Tiemann K, Simonis G, Campo dell’ Orto M, von Bardeleben S (2014) Empfehlungen zur Notfallechokardiographie. Kardiologe 8:45–64

    Article  Google Scholar 

  27. Wise D et al (2005) Emergency thoracotomy: “how to do it”. Emerg Med J 22(1):22–24

    Article  CAS  Google Scholar 

  28. Rudolph M, Heinz W, Kosa R, Conrad G, Braun J, Popp E (2016) Schockursache Perikardtamponade: Ein Fallbericht. Notfall Rettungsmed 19:283–286

    Article  Google Scholar 

  29. Harris DG et al (2003) Delayed pericardial effusion following stab wounds to the chest. Eur J Cardiothorac Surg 23(4):473–476

    Article  Google Scholar 

  30. Tsang TS et al (1998) Rescue echocardiographically guided pericardiocentesis for cardiac perforation complicating catheter-based procedures. The Mayo Clinic experience. J Am Coll Cardiol 32(5):1345–1350

    Article  CAS  Google Scholar 

  31. Kleber C et al (2013) Trauma-related preventable deaths in Berlin 2010: need to change prehospital management strategies and trauma management education. World J Surg 37(5):1154–1161

    Article  CAS  Google Scholar 

  32. Rhee PM et al (2000) Survival after emergency department thoracotomy: review of published data from the past 25 years. J Am Coll Surg 190(3):288–298

    Article  CAS  Google Scholar 

  33. Working Group, Subcommittee on Outcomes, American College of Surgeons, Committee on Trauma. (2001) Practice management guidelines for emergency department thoracotomy. Working Group, Ad Hoc Subcommittee on Outcomes, American College of Surgeons-Committee on Trauma. J Am Coll Surg 193(3):303–309

    Article  Google Scholar 

  34. Burlew CC et al (2012) Western Trauma Association critical decisions in trauma: resuscitative thoracotomy. J Trauma Acute Care Surg 73(6):1359–1363

    Article  Google Scholar 

  35. Davies GE, Lockey DJ (2011) Thirteen survivors of prehospital thoracotomy for penetrating trauma: a prehospital physician-performed resuscitation procedure that can yield good results. J Trauma 70(5):E75–E78

    Article  Google Scholar 

  36. Van Vledder MG et al (2017) Out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma. Injury 48(9):1865–1869

    Article  Google Scholar 

  37. Suzuki K et al (2016) Comparative effectiveness of emergency resuscitative thoracotomy versus closed chest compressions among patients with critical blunt trauma: a nationwide cohort study in Japan. PLoS ONE 11(1):e145963

    Article  Google Scholar 

  38. Hall BL, Buchman TG (2005) A visual, timeline-based display of evidence for emergency thoracotomy. J Trauma 59(3):773–777

    PubMed  Google Scholar 

  39. Lockey DJ, Brohi K (2017) Pre-hospital thoracotomy and the evolution of pre-hospital critical care for victims of trauma. Injury 48(9):1863–1864

    Article  CAS  Google Scholar 

  40. Seamon MJ et al (2015) An evidence-based approach to patient selection for emergency department thoracotomy: a practice management guideline from the eastern association for the surgery of trauma. J Trauma Acute Care Surg 79(1):159–173

    Article  Google Scholar 

  41. Puchwein P et al (2015) Clamshell thoracotomy and open heart massage – a potential life-saving procedure can be taught to emergency physicians: an educational cadaveric pilot study. Injury 46(9):1738–1742

    Article  Google Scholar 

  42. Gries A, Wilhelm W (2004) Deficiencies in the practical management of certain emergency situations. Improvement in the emergency medical qualifications through practice oriented course concepts. Anaesthesist 53(11):1043–1044

    Article  CAS  Google Scholar 

  43. Zink W et al (2004) Invasive techniques in emergency medicine. I. Practice-oriented training concept to ensure adequately qualified emergency physicians. Anaesthesist 53(11):1086–1092

    Article  CAS  Google Scholar 

  44. Berg DA et al (2005) Successful collaborative model for trauma skills training of surgical and emergency medicine residents in a laboratory setting. Curr Surg 62(6):657–662 (discussion 663)

    Article  Google Scholar 

  45. Tabas JA et al (2005) A comprehensive, unembalmed cadaver-based course in advanced emergency procedures for medical students. Acad Emerg Med 12(8):782–785

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sektion Notfallmedizin, Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    N. Schneider,  T. Küßner, F. Weilbacher, M. Göring, S. Mohr, M. Rudolph & E. Popp

  2. DRF Stiftung Luftrettung gemeinnützige AG, Rita-Maiburg-Str. 2, 70794, Filderstadt, Deutschland

    M. Rudolph

Authors
  1. N. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Küßner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Weilbacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Göring
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Mohr
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Rudolph
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E. Popp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Küßner.

Ethics declarations

Interessenkonflikt

N. Schneider, T. Küßner, F. Weilbacher, M. Göring, S. Mohr, M. Rudolph und E. Popp geben an, dass kein Interessenkonflikt besteht.

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

Additional information

Redaktion

B. Gliwitzky, Maikammer

E. Popp, Heidelberg

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schneider, N., Küßner, T., Weilbacher, F. et al. Invasive Notfalltechniken – INTECH Advanced. Notfall Rettungsmed 22, 87–99 (2019). https://doi.org/10.1007/s10049-018-0475-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10049-018-0475-y

Schlüsselwörter

Keywords

Search

Navigation