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Behandlung von polytraumatisierten Patienten

Zusammenfassung der aktualisierten europäischen Leitlinien

Treatment of massive bleeding

Summary of the updated European guidelines

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Zusammenfassung

Die Akutbehandlung polytraumatisierter Patienten mit Massenblutungen stellt trotz verbesserter chirurgischer und konventioneller Therapien eine besondere interdisziplinäre Herausforderung dar. Die epidemiologische Bedeutung dieses komplexen Krankheitsbilds ergibt sich aus der hohen Zahl von 5 Mio. Menschen, die weltweit jährlich an den Folgen eines Traumas sterben. Da traumaassoziierte Massenblutungen auf dem Boden einer Koagulopathie potenziell vermeidbar und behandelbar sind, gilt die Exsanguination als die häufigste vermeidbare Komplikation, die zum frühen Versterben nach Trauma führt. Mit dem Ziel, Behandlungsalgorithmen nach dem aktuellen Stand der Wissenschaft für die Versorgung schwer verletzter Patienten mit Gerinnungsstörungen zu entwickeln, wurde die „Task Force for Advanced Bleeding Care in Trauma“ 2005 gegründet. Die Erstveröffentlichung aus dem Jahr 2007 wurde entsprechend den Grundsätzen der „evidence-based medicine“ unter Berücksichtigung neuer klinischer Studien in überarbeiteter Form publiziert. Der vorliegende Beitrag gibt einen Überblick über die einzelnen Empfehlungen unter besonderer Berücksichtigung wesentlicher Neuerungen.

Abstract

Despite improved strategies in the treatment of polytraumatized patients the mortality rate of severely injured patients remains high. Thus, worldwide 5 million patients die due to trauma or trauma-related complications each year. As the majority of early trauma-related deaths are attributed to or caused by exsanguination the prevention and treatment of coagulopathy is of paramount significance. With the aim of developing guidelines and improve strategies to treat polytraumatized patients the multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2005. Under consideration of new clinical studies, an updated version of the original publication from 2007 has recently been published. Based on a systematic review of published literature the recommendations were formed according to “Grading of Recommendations Assessment, Development and Evaluation” (GRADE). This publication summarizes the main recommendations with a special emphasis on revisions and new aspects.

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Interessenkonflikt

O.G.: Im Rahmen experimenteller Studien wurden dem korrespondierenden Autor rFVIIa (NovoSeven®; Novo Nordisk), Fibrinogen (Haemocomplettan®, CSL Behring) und PPSB (Cofact®, Biotest) zur Verfügung gestellt. Außerdem erhielt O.G. Forschungsförderung von der Fa. Biotest.

R.R.: Der Koautor erhielt von den Firmen CSL Behring, Novo Nordisk, Bayer, Air Liquide Honorare für Vorlesungen und Beratertätigkeiten. Außerdem erhielt R.R. Forschungsförderung von den Firmen AGA-Linde, Air Liquide, Novo Nordisk, Eli Lilly and Glaxo Wellcome.

D.R.S.: Die Abteilung für Anästhesiologie erhält Förderung von den folgenden Institutionen bzw. Firmen: Universität Zürich, Zürich, Schweiz; the Research Award Center for Zurich Integrative Human Physiology, Zürich, Schweiz; the Swiss National Science Foundation, Bern, Schweiz (Fördernummer: SPUM 33CM30_124117); the European Society of Anaesthesiology (ESA), Brüssel, Belgien; the Swiss Society of Anesthesiology and Reanimation (SGAR), Bern, Schweiz; the Swiss Foundation for Anesthesia Research, Zürich, Schweiz; the Swiss Life Foundation Switzerland, Zürich, Schweiz; Bundesprogramm Chancengleichheit, Bern, Schweiz; Stiftung für Staublungen-Forschung, Zürich, Schweiz; B. Braun, Sempach, Schweiz; CSL Behring, Bern, Schweiz; Vifor SA, Villars-sur-Glâne, Schweiz, und UBS, Zürich, Schweiz.

D.R.S. ist Vorsitzender der „ABC Faculty“ und Mitglied der „ABC Trauma Faculty“, die von der Thomson Physicians World GmbH, Mannheim, Deutschland, und durch Novo Nordisk A/S, Bagsvärd, Dänemark, gefördert werden.

In den vergangenen 5 Jahren erhielt D.R.S. Honorare für Vorlesungen und Beratertätigkeiten von den folgenden Firmen: Abbott AG, Baar, Schweiz; AstraZeneca AG, Zug, Schweiz; Bayer (Schweiz) AG, Zürich, Schweiz; B. Braun Melsungen AG, Melsungen, Deutschland; Boehringer Ingelheim (Schweiz) GmbH, Basel, Schweiz; Bristol-Myers-Squibb, Rueil-Malmaison Cedex, Frankreich; CSL Behring GmbH, Hattersheim a. M., Deutschland, und Bern, Schweiz; Curacyte AG, München, Deutschland; Ethicon Biosurgery, Sommerville, New Jersey, USA; Fresenius SE, Bad Homburg v.d.H., Deutschland; Galenica AG, Bern, Schweiz (inbegriffen Vifor SA, Villars-sur-Glâne, Schweiz); GlaxoSmithKline GmbH & Co. KG, Hamburg, Deutschland; Janssen-Cilag AG, Baar, Schweiz; Novo Nordisk A/S, Bagsvärd, Dänemark; Octapharma AG, Lachen, Schweiz; Organon AG, Pfäffikon/SZ, Schweiz; Oxygen Biotherapeutics, Costa Mesa, Kalifornien; Pentapharm GmbH (tem International), München, Deutschland; Roche Pharma (Schweiz) AG, Reinach, Schweiz, und Schering-Plough International, Inc., Kenilworth, New Jersey, USA.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    O. Grottke & R. Rossaint

  2. Institut für Anästhesiologie, Universitätsspital Zürich, Zürich, Schweiz

    D.R. Spahn

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  1. O. Grottke
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  2. D.R. Spahn
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  3. R. Rossaint
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Correspondence to O. Grottke.

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Grottke, O., Spahn, D. & Rossaint, R. Behandlung von polytraumatisierten Patienten. Anaesthesist 60, 546–554 (2011). https://doi.org/10.1007/s00101-011-1880-5

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