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Intraossäre Infusion beim Erwachsenen

Intraosseous infusion for adults

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Zusammenfassung

In der Notfallmedizin ist bei Säuglingen und Kindern die Anwendung intraossärer Infusionstechniken weit verbreitet. Bereits 1998 haben sie als etablierte Maßnahme Eingang in die Empfehlungen und Leitlinien des European Resuscitation Council (ERC) gefunden. Ihre Bedeutung in der notfallmedizinischen Behandlung Erwachsener ist bis heute weit geringer.

Die hier vorliegende Literaturübersicht stellt die Bedeutung intraossärer Infusionstechniken beim Erwachsenen dar und beschreibt die heute auf dem Markt verfügbaren und am häufigsten eingesetzten Systeme. Obwohl jedes dieser Systeme Stärken und Grenzen aufweist, lässt sich mit allen selbst unter widrigen Bedingungen rasch ein Gefäßzugang etablieren. Dabei bieten intraossäre (IO-)Zugänge nicht nur therapeutische, sondern auch diagnostische Möglichkeiten, wie zahlreiche Anwenderuntersuchungen in der Präklinik und Klinik zeigen. Mittels IO-Techniken lässt sich meist innerhalb von 1–2 min ein Gefäßzugang etablieren, ihre Handhabung ist einfach und zuverlässig. Die Flussraten sind zwar geringer als die großlumiger peripherer Venenzugänge, aber mit einer Druckmanschette sind auch Infusionen zur Volumentherapie möglich. Die meisten intravenös applizierbaren Medikamente können auch intraossär gegeben werden, in gleicher Dosierung und mit gleicher Wirkung. Dennoch sind Grenzen und Risiken der intraossären Infusionstechniken zu beachten.

Abstract

Intraosseous (IO) infusion methods have been common for emergency treatment in infants and children for years. The role of IO access in adults is however much less clear, but its importance in this patient group is increasing, and different devices are available today. Each device has strengths and weaknesses, but all achieve rapid vascular access even in challenging situations. The potential of IO access regarding both therapeutic and diagnostic options has been shown in several operational studies in and out of hospital. Insertion times require between 1 and 2 min in most cases, while insertion and handling of the IO access devices seem to be easy and reliable. The flow rates of IO access devices for adults are lower than those of large-bore peripheral intravenous catheters, but fluid resuscitation is possible in most cases at least with pressure bag infusion systems. Most drugs administered intravenously can be given intraosseously in equivalent dosages and with the same effects. Nevertheless the limitations and risks of IO access routes need to be considered for each application. Rapid IO access is now possible in all age groups, and the 2005 AHA Guidelines favor it over drug administration via the endotracheal tube.

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  1. Chirurgische Klinik und Poliklinik, Klinikum der Universität München– Innenstadt, Nußbaumstr. 20, 80336, München, Deutschland

    B.A. Leidel, K.G. Kanz, W. Mutschler & C. Kirchhoff

  2. Luftrettungszentrum „Christoph München“, HDM Luftrettung, Team DRF, Klinikum der Universität, München – Großhadern, Deutschland

    B.A. Leidel

  3. EMQ Helicopter Rescue Cairns, Emergency Management Queensland und CareFlight Medical Services QLD, Queensland , Australien

    B.A. Leidel

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Leidel, B., Kanz, K., Mutschler, W. et al. Intraossäre Infusion beim Erwachsenen. Chirurg 79, 315–326 (2008). https://doi.org/10.1007/s00104-007-1445-y

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