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Einfluss von Rettungsmittel und Zielklinik auf die Letalität nach Polytrauma

Eine Standortbestimmung

Impact of rescue pathway and hospital volume on the mortality of polytraumatized patients

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Zusammenfassung

Hintergrund

Ziel der vorliegenden Arbeit war es, den aktuellen Wissensstand 1. zur Effektivität der Luftrettung und 2. zum Einfluß der Kategorie der primären Zielklinik auf die Letalität polytraumatisierter Patienten zu dokumentieren.

Methodik

Systematische Literaturanalyse (1970–2003) und Identifikation aller Arbeiten mit mindestens Evidenzniveau III (retrospektive Kohortenstudie) und Kontrollgruppe; eigene Ergebnisse.

Ergebnisse

Ad 1: 17 Studien zu dieser Fragestellung wurden erfasst und ausgewertet. In keiner Arbeit sind Zeitvorteile durch den Einsatz der Luftrettung nachweisbar. 11/17 Studien weisen einen statistisch signifikanten Überlebensvorteil (8,2% bis 52%) insbesondere bei mittlerer Verletzungsschwere durch den Einsatz der Luftrettung nach. Ad 2: Alle 6 Studien belegen eine deutliche Senkung der Letalität (19% bis 42%) bei primärer klinischer Behandlung in einem Traumazentrum oder einer Klinik vergleichbarer Versorgungsqualität.

Schlussfolgerungen

Die analysierten Studien lassen einen Trend zu besseren Ergebnissen durch den Einsatz der Luftrettung erkennen. Bei gleicher Zielklinik und eindeutigen Zeitnachteilen der Luftrettung kann dieser durch eine bessere klinische Diagnostik und Behandlung aufgrund von Ausbildungs- und Erfahrungsvorteilen des RTH-Teams erklärt werden. Die Letalität kann zudem durch eine primäre Behandlung in einem Traumazentrum oder einer Klinik vergleichbarer Versorgungsqualität signifikant gesenkt werden. Die freie Wahl der Zielklinik auch über größere Entfernung verbleibt daher als spezifischer, klinisch relevanter Vorteil des Einsatzes von Hubschraubern in der Unfallrettung.

Abstract

Background

The aim of this study was to document the present knowledge from the medical literature on (1.) efficacy of aeromedical evacuation (helicopter emergency medical service, HEMS) and (2.) influence of the level of the first receiving hospital on mortality of patients.

Methods

Systematic review of the literature between 1970 and 2003; identification of studies with an evidence level of at least III and included control group; own results.

Results

(1.) 17 studies concerning the efficacy of HEMS were included into the review. No single study yielded shorter rescue times with the use of HEMS. 11 of 17 studies showed a significantly higher survival rate (8.2 to 52%) with the employment of HEMS especially with mid-degree polytrauma. (2.) All 6 relevant studies dealing with hospital level found a considerable lower mortality rate (19 to 42%) for patients treated primarily at a level 1 trauma center or comparable institution.

Conclusions

The analyzed studies showed a trend toward decreased mortality rates with the employment of HEMS. Considering the comparable hospital level and even longer rescue times with HEMS, these differences can be explained with higher quality of initial diagnosis and treatment of the HEMS rescue team. Furthermore, mortality rates can be lowered significantly through primary treatment at a level 1 trauma center. Thus, the more flexible choice of the first receiving hospital represents a specific, clinically relevant advantage of HEMS in emergency medicine.

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Authors and Affiliations

  1. Klinik und Poliklinik für Unfall- und Wiederherstellungschirurgie, Klinikum Carl Gustav Carus, Technische Universität, Dresden

    A. Biewener, U. Aschenbrenner, S. Sauerland, H. Zwipp, S. Rammelt & J. Sturm

  2. Klinik und Poliklinik für Unfall- und Wiederherstellungschirurgie, Klinikum Carl Gustav Carus, Technische Universität, Fetscherstraße 74, 01307, Dresden

    A. Biewener

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  1. A. Biewener
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  2. U. Aschenbrenner
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  3. S. Sauerland
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  4. H. Zwipp
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  5. S. Rammelt
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AG Notfallmedizin der DGU

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Mitglieder der AG-Notfallmedizin der DGU: H. Bail (Berlin), M. Bardenheuer (Heidelberg), M. Bayeff-Filloff (Rosenheim), A. Beck (Ulm), B. Bouillon (Köln), M. Fischbacher (Essen), S. Günther (Essen), S. Hentsch (Berlin), E. Hüls (Celle), K.G. Kanz (München), W. Köstler (Freiburg), C. Lackner (München), I. Marintschev (Halle), G. Matthes (Greifswald), H. Mayer (Augsburg), W. Mutschler (München), U. Obertacke (Mannheim), H.J. Oestern (Celle), A. Prokop (Köln), M. Raum (Köln), U. Schaechinger (Regensburg), E. Stolpe (München), F. Walcher (Frankfurt), C. Waydhas (Essen), M. Weinlich, C. Wölfel (Ludwigshafen), G. Zimmermann (Ludwigshafen), R. Zinser (Ludwigshafen)

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Biewener, A., Aschenbrenner, U., Sauerland, S. et al. Einfluss von Rettungsmittel und Zielklinik auf die Letalität nach Polytrauma. Unfallchirurg 108, 370–377 (2005). https://doi.org/10.1007/s00113-005-0928-x

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