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„Resuscitative endovascular balloon occlusion of the aorta“

Option für nichtkomprimierbare Körperstammblutungen?

Resuscitative endovascular balloon occlusion of the aorta

Option for incompressible trunk bleeding?

  • Notfallmedizin
  • Published:
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Zusammenfassung

Verbluten ist beim Traumapatienten die häufigste vermeidbare Todesursache. Dabei finden sich im zivilen Rettungsdienst in Europa lebensbedrohliche Blutungen meist in nichtkomprimierbaren Körperregionen wie dem Abdomen oder dem Becken. Zur raschen Kontrolle von schwersten Blutungen in diesen Bereichen wird daher in letzter Zeit das v. a. im Bereich der Gefäßchirurgie etablierte Verfahren der aortalen Ballonokklusion auch für die notfallmäßige Versorgung von Traumapatienten propagiert.

Im vorliegenden Artikel wird zum einen eine umfassende Übersicht über die Technik, mögliche Indikationen, Kontraindikationen und Komplikationen der notfallmäßigen endovaskulären Ballonokklusion der Aorta („resuscitative endovascular balloon occlusion of the aorta“, REBOA) geboten. Zum anderen werden die bisher berichteten Behandlungsergebnisse aus der verfügbaren Literatur zusammengefasst und diskutiert, um hieraus mögliche praxisrelevante Konsequenzen für die zukünftige Etablierung der REBOA im Bereich der Notfallmedizin abzuleiten.

Abstract

Hemorrhage is the single largest cause of avoidable death in trauma patients, whereby in civil emergency medicine in Europe most life-threatening hemorrhages occur in the abdomen and the pelvis. This is one reason why endovascular balloon occlusion of the aorta (EBOA), a procedure especially established in vascular surgery, is increasingly propagated for rapid bleeding control in these patients. This review article provides a comprehensive overview of the technique, indications, contraindications and complications of resuscitative endovascular balloon occlusion of the aorta (REBOA). Additionally, outcomes reported in in the currently available literature are summarized and discussed. From this practical and user-oriented consequences for future successful introduction of REBOA in the field of emergency medicine are deduced.

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Danksagung

Ein herzlicher Dank an Prytime Medical Boerne, Texas, USA, für die kostenlose Freigabe der Abb. 1a und 2 sowie an Medtronic Santa Rosa, Kalifornien, USA, für die kostenlose Freigabe der Abb. 1b.

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Authors and Affiliations

  1. Universitätsklinik für Anästhesiologie und Schmerztherapie, Universitätsspital Bern, Freiburgstrasse 8, Bern, Schweiz

    J. Knapp DESA EDIC MHBA

  2. Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland

    M. Bernhard

  3. Universitätsklinik für Viszerale Chirurgie und Medizin, Universitätsspital Bern, Bern, Schweiz

    T. Haltmeier

  4. Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs- und Handchirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland

    D. Bieler

  5. Klinik für Anästhesiologie und Intensivmedizin/Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland

    B. Hossfeld & M. Kulla

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  1. J. Knapp DESA EDIC MHBA
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Correspondence to J. Knapp DESA EDIC MHBA.

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J. Knapp, M. Bernhard, T. Haltmeier, D. Bieler, B. Hossfeld und M. Kulla geben an, keine Interessenkonflikte im Rahmen der vorgelegten Publikation zu haben. M. Kulla gibt an, Fördermittel vom Bundesministerium der Verteidigung (FKZ 34K3-17 1515 Digipen und 37K3-S-20 1616 Patientenzufriedenheit mit der Behandlung in einer zentralen Notaufnahme) und weitere Fördermittel vom BMBF (Verbundprojekt: AKTIN Verbesserung der Versorgungsforschung in der Akutmedizin durch den Aufbau eines nationalen Notaufnahmeregisters) sowie „ENQuIRE – Evaluierung der Qualitätsindikatoren von Notaufnahmen auf Outcome-Relevanz für den Patienten“ (VSF1_2017-020) außerhalb der eingereichten Arbeit erhalten zu haben.

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Knapp, J., Bernhard, M., Haltmeier, T. et al. „Resuscitative endovascular balloon occlusion of the aorta“. Anaesthesist 67, 280–292 (2018). https://doi.org/10.1007/s00101-018-0418-5

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