Clamshell-Thorakotomie im Rettungsdienst und Schockraum: Indikationen, Anforderungen und Technik

 

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Zusammenfassung

Die Notfallthorakotomie beim traumatischen Herz-Kreislauf-Stillstand spielte in Deutschland lange Zeit eine untergeordnete Rolle. Nach der Veröffentlichung der Reanimationsleitlinien des ERCs 2015 rückte der Algorithmus zur Versorgung dieses Verletzungsmusters in den Mittelpunkt, und speziell die Notfallthorakotomie war Auslöser einiger kontroverser Diskussionen. Die vorliegende Arbeit beschreibt nun die Indikationen für eine Thorakotomie im Rahmen einer Reanimation und erläutert die nötigen Rahmenbedingungen. Weiterhin wird die Technik Schritt für Schritt beschrieben. Darüber hinaus erfolgt eine kritische Betrachtung der Implementierung der Technik in unser Rettungsdienstsystem sowie der Hinweis auf bestehende Schulungskonzepte.

Abstract

In Germany in the past resuscitative thoracotomy in traumatic cardiac arrest did not get a lot of attention. With the publication of the 2015 ERC Guidelines the revised algorithm for the treatment of reversible causes of traumatic cardiac arrest gained a lot of attention, highlighting the possibly lifesaving impact of resuscitative thoracotomy, hence sparking some controversial discussions. The aim of this paper is to give a step by step description of the technique and to describe indications for resuscitative thoracotomy and to highlight the required prerequisites. Furthermore it provides a critical review of the implementation of resuscitative thoracotomy into a pre hospital care system and summarizes current training concepts.

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