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Präklinisches Management von Rückenmarkverletzungen

Prehospital management of spinal cord injuries

  • Notfallmedizin
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Zusamenfassung

Von den jeweils mehr als 10.000 Patienten, die jährlich in den USA und in Europa eine Rückenmarkverletzung (RMV) erleiden, sterben ca. 20% bereits vor Aufnahme in die Klinik. Weil bis zu 25% der RMV erst nach dem initialen Ereignis entstehen bzw. aggraviert werden, ist das präklinische Management wichtig. Hierzu gehören: Untersuchung des Patienten, Immobilisation der Wirbelsäule, Atemwegsmanagement unter strenger Indikationsstellung, kardiovaskuläre Stabilisierung mit Aufrechterhaltung eines mittleren arteriellen Drucks (MAP) über 90 mmHg sowie Stabilisierung einer Blutglukosekonzentration im Normbereich. Aus evidenzbasierter Sicht ist unbekannt, ob zusätzliche spezielle Therapiemaßnahmen von Nutzen sind. Bisher konnte nicht überzeugend belegt werden, dass Methylprednisolon (MPS) oder andere Substanzen einen klinisch wichtigen Benefit haben. Auch aktuelle US-amerikanische Stellungnahmen unterstützen nicht mehr die Therapie mit MPS bei RMV im prähospitalen Setting. Darüber hinaus ist unbekannt, ob die therapeutische Hypothermie oder andere pharmakologische Interventionen positiv wirken. Koordination und Durchführung weiterer klinischer Studien scheinen notwendig, um das Outcome der Patienten weiter zu verbessern.

Abstract

In both the United States and Europe about 10,000 patients suffer from spinal cord injury (SCI) each year and 20% die before being admitted to hospital. Prehospital management of SCI is very important since 25% of SCI damage may occur after the initial event. Emergency treatment includes examination of the patient, spinal immobilization, careful airway management, cardiovascular stabilization (maintenance of mean arterial blood pressure above 90 mmHg) and glucose levels within the normal range. From an evidence-based point of view, it is still not known whether additional specific therapy is useful and studies have not convincingly demonstrated that methylprednisolone (MPS) or other substances have clinically important benefits. Recently published statements from the US do not support the therapeutic use of MPS in patients suffering from SCI in the prehospital setting. Moreover, it is not known whether hypothermia or any other pharmacological interventions have beneficial effects. Networks for clinical studies in SCI patients should be established as a basic requirement for further improvement in outcome in these patients.

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Authors and Affiliations

  1. Klinik für Anaesthesiologie, Universitätsklinikum Heidelberg

    M. Bernhard, A. Gries & B. W. Böttiger

  2. Deutsche Rettungsflugwacht, Luftrettungszentrum „Christoph 53“, Mannheim

    A. Gries

  3. Neurochirurgische Klinik, Universitätsklinikum Heidelberg

    P. Kremer

  4. Deutsches Krebsforschungszentrum, Heidelberg

    A. Martin-Villalba

  5. Klinik für Anaesthesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg

    M. Bernhard

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  1. M. Bernhard
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  2. A. Gries
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  3. P. Kremer
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  4. A. Martin-Villalba
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  5. B. W. Böttiger
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Correspondence to M. Bernhard.

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Bernhard, M., Gries, A., Kremer, P. et al. Präklinisches Management von Rückenmarkverletzungen. Anaesthesist 54, 357–376 (2005). https://doi.org/10.1007/s00101-005-0807-4

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