Zusammenfassung
Hintergrund
In sämtlichen Ausbildungsprogrammen zur Traumabehandlung und auch in der S3-Leitlinie „Polytrauma/Schwerverletztenbehandlung“ wird eine Intubation bei einem Glasgow-Coma-Scale(GCS)-Wert von kleiner als 9 empfohlen. Die vorhandene Evidenz für diese Aussage ist jedoch eher gering. Diese Studie analysiert den Effekt der präklinischen Intubation auf die Mortalität bei schwerstverletzten Patienten mit einem GCS < 9.
Methodik
Die retrospektive Auswertung wurde für die Jahre 2002 bis 2012 vorgenommen. Es wurden die Daten aus der Klinik der Autoren für das Traumaregister der DGU® verwendet. Nach Anwendung der Einschlusskriterien, ISS ≥ 16, GCS < 9 und primäre Verlegung vom Unfallort, verblieben 455 Patienten. Zusätzlich erfolgte eine Matched-pair-Analyse von 62 Patienten.
Ergebnisse
In beiden Analysen fand sich keine verbesserte Mortalitätsrate nach Intubation. In der retrospektiven Analyse war der systolische Blutdruck bei Ankunft im Schockraum signifikant geringer. Intubierte Patienten erhielten in allen Phasen der Behandlung signifikant mehr Volumen infundiert. Die präklinische Rettungszeit war in der Gruppe der Intubierten signifikant verlängert. In der Matched-pair-Analyse fand sich als signifikanter Unterschied zwischen den beiden Gruppen lediglich noch das höhere infundierte Volumen in der Gruppe der intubierten Patienten. Diese Patienten hatten beim Eintreffen im Schockraum auch eine bessere periphere Sauerstoffsättigung. Weitere Unterschiede zwischen den Gruppen konnten nicht gefunden werden.
Zusammenfassung
Die präklinische Intubation bei GCS < 9 scheint zu keinem besseren Outcome zu führen. Die präklinische Intubation war mit einem erniedrigten systolischen Blutdruck bei Ankunft, einer Verlängerung der präklinischen Rettungszeit und mit einer erhöhten Volumensubstitution vergesellschaftet.
Abstract
Background
Training programs for the treatment of trauma patients generally recommend establishing a secure airway if the patient presents with a Glasgow coma scale (GCS) score of less than 9; however, the evidence for its effectiveness is rather sparse. This study analyzed the effect of preclinical intubation on mortality of patients with a GCS < 9 in an emergency medical situation.
Methods
This retrospective analysis included patients who were primarily admitted to a German level 1 trauma center between 2002 and 2012 with an injury severity score (ISS) ≥ 16, a GCS < 9 and primary transport from the site of the accident. Data were collected from the trauma registry of the German Society for Trauma Surgery and from hospital records. A total of 455 patients were included and a matched-pair analysis of 62 patients was conducted.
Results
Both analytical methods showed no significant reduction in mortality rate after prehospital intubation. In the retrospective analysis intubated patients presented with a significantly lower systolic blood pressure on admission, received a higher amount of fluid volume at all phases of treatment and arrived at the hospital after a prolonged rescue time. In the matched-pair analysis, intubated patients also received a higher amount of fluid volume and showed better peripheral oxygen saturation on admission. No further differences between the groups could be found.
Conclusion
It appears that preclinical intubation in trauma patients with a GCS < 9 does not result in a better outcome. The preclinical intubation resulted in a reduced systolic blood pressure on arrival at hospital, a prolonged preclinical rescue time and a greater amount of infused fluid volume.
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C. Schoeneberg, A. Wegner, M.D. Kauther, M. Stuermer, T. Probst, S. Lendemans geben an, dass kein Interessenkonflikt besteht.
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H. Polzer, München
Teile dieser Arbeit wurden als Vortrag auf dem DKOU 2014 präsentiert.
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Schoeneberg, C., Wegner, A., Kauther, M. et al. Kein verbessertes Überleben bei schwerstverletzten Patienten durch die präklinische Intubation. Unfallchirurg 119, 314–322 (2016). https://doi.org/10.1007/s00113-015-0116-6
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DOI: https://doi.org/10.1007/s00113-015-0116-6