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Erschienen in: Die Unfallchirurgie 7/2018

13.06.2018 | Schock | Leitthema

„Resuscitative endovascular balloon occlusion of the aorta“

Überbrückende Maßnahme bis zur operativen Versorgung

verfasst von: Dr. K. Elias, M. Engelhardt

Erschienen in: Die Unfallchirurgie | Ausgabe 7/2018

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Zusammenfassung

Hintergrund

Unbeherrschbare Blutungen sind nach wie vor die häufigste Todesursache bei Unfallopfern. Die „resuscitative balloon occlusion of the aorta“ (REBOA) stellt eine endovaskuläre Alternative zur etablierten Notfallthorakotomie mit aortalem „cross-clamping“ bei Patienten mit schwerer abdomineller oder pelviner Blutung dar.

Ziel der Arbeit

Der Beitrag vermittelt erste Erfahrungen mit REBOA.

Methode

Anhand der aktuellen Literatur und eigener Erfahrungen werden die pathophysiologischen Hintergründe, Indikationen, Kontraindikationen, technische Details und erste Ergebnisse mit REBOA dargestellt.

Ergebnisse

Das Verfahren ist indiziert bei Patienten im therapierefraktären hämorrhagischen Schock mit abdomineller oder pelviner Blutung. Über einen transfemoralen Zugang wird ein Okklusionsballon in der Aorta platziert und gefüllt. Je nach Indikation erfolgt die aortale Okklusion supradiaphragmal (Zone I) oder infrarenal (Zone III). Experimentelle Ergebnisse belegen einen signifikanten Anstieg des zentralen Perfusionsdrucks durch das Manöver. Erste klinische Daten deuten darüber hinaus eine Verbesserung der Überlebensrate von Traumapatienten an. Mit Weiterentwicklung der Katheter und Minimierung des Zugangstraumas durch Einführung von kleinlumigen 7‑F-Schleusen konnte die perioperative Komplikationsrate gesenkt werden.

Schlussfolgerung

„Resuscitative endovascular balloon occlusion of the aorta“ ist ein vielversprechendes endovaskuläres Verfahren zur temporären Kreislaufstabilisierung von Patienten im hämorrhagischen Schock. Die klinische Überlegenheit der Technik gegenüber der klassischen Notfallthorakotomie muss jedoch erst in größeren Registerstudien belegt werden.
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Metadaten
Titel
„Resuscitative endovascular balloon occlusion of the aorta“
Überbrückende Maßnahme bis zur operativen Versorgung
verfasst von
Dr. K. Elias
M. Engelhardt
Publikationsdatum
13.06.2018
Verlag
Springer Medizin
Schlagwörter
Schock
Thorakotomie
Schock
Erschienen in
Die Unfallchirurgie / Ausgabe 7/2018
Print ISSN: 2731-7021
Elektronische ISSN: 2731-703X
DOI
https://doi.org/10.1007/s00113-018-0503-x

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