Zusammenfassung
Durch unkontrollierte Blutungen werden 40% aller traumabedingten Todesfälle verursacht. Zunehmend wird auf die Schlüsselrolle der akuten posttraumatischen Gerinnungsstörung im Rahmen der Versorgung schwerstverletzter Patienten hingewiesen. In der vorliegenden Synopse werden Inzidenz, derzeitig diskutierte Ursachen und Trigger dieser Störung vorgestellt sowie Möglichkeiten der frühen Risikostratifizierung und daraus resultierende Empfehlungen für eine differenzierte Transfusionstherapie zur Kontrolle der akuten posttraumatischen Blutung diskutiert. Bei Hochrisikopatienten scheint ein ausgewogenes Transfusionsverhältnis zwischen Erythrozytenkonzentraten und Frischplasmakonzentraten mit einem Überlebensvorteil assoziiert zu sein.
Abstract
Of all trauma-related deaths 40% are due to exsanguination. The causes for acute, hemorrhaging are uncontrolled bleeding sources and the development of acute posttraumatic coagulopathy. Clinical observations and recent research results emphasize the key role of this disorder in acute trauma care. The present synopsis summarizes the results from different analyses based on datasets from severely injured patients derived from the Trauma Register of the German Trauma Society (DGU) on frequency, potential triggers and strategies to manage acute posttraumatic coagulopathy. In an extension to this work a clinical scoring system for early identification of patients at high risk for ongoing bleeding is presented. High risk patients seem to benefit from a more balanced transfusion regimen.
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Peiniger, S., Maegele, M. Traumaassoziierte Blutung beim Schwerverletzten. Unfallchirurg 115, 173–183 (2012). https://doi.org/10.1007/s00113-010-1860-2
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DOI: https://doi.org/10.1007/s00113-010-1860-2