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Präklinische Immobilisation der Wirbelsäule

Freund oder Feind des Traumapatienten?

Pre-clinical spinal immobilisation

Friend or foe of trauma patients?

  • Konzepte – Stellungnahmen – Leitlinien
  • Published:
Notfall + Rettungsmedizin Aims and scope Submit manuscript

Zusammenfassung

Hintergrund und Fragestellung

Die Frage der notwendigen Immobilisation des Traumapatienten im Allgemeinen sowie die verschiedenen Durchführungen dieser Maßnahme im Speziellen werden in der wissenschaftlichen Literatur zunehmend kontrovers diskutiert. Des Weiteren zeigt sich auch in der täglichen Praxis der Notfallmedizin kein einheitliches Vorgehen. Ziel des vorliegenden Artikels ist es, einen Überblick über die exemplarisch ausgewählte Literatur zum Themenkomplex „Wirbelsäulen-Immobilisation des Traumapatienten“ zu geben und hieraus mögliche Handlungsempfehlungen abzuleiten.

Immobilisation beim Traumapatienten

Bei generell fehlender Evidenz für oder gegen eine Wirbelsäulen-Immobilisation finden sich in der Literatur zunehmend Hinweise, dass die alleinige Anlage einer Zervikalstütze keine ausreichende Immobilisation der Halswirbelsäule gewährleistet. Die geforderte Ganzkörper-Immobilisation des Traumapatienten kann allerdings auch mit erheblichen Komplikationen wie erschwertem Atemwegsmanagement oder Einschränkungen der Lungenfunktion einhergehen. Ferner kann auch die alleinige Anlage einer Zervikalstütze zur Steigerung des Hirndrucks führen. Die Indikationsstellung zur Wirbelsäulen-Immobilisation sollte deshalb differenziert anhand von Entscheidungshilfen, wie z. B. der Canadian C-Spine Rule, getroffen werden. Bei Patienten mit instabilen Kreislaufverhältnissen muss entschieden werden, ob der zügige Transport durch die Immobilisation verzögert werden kann. Liegt bei einem Traumapatienten ein symptomatisches schweres Schädel-Hirn-Trauma vor, sollte abgewogen werden, ob die Anlage einer Zervikalstütze zwingend erforderlich ist oder ob eine anderweitige Möglichkeit der Immobilisation besteht. Hier bietet die Vakuummatratze bessere Stabilität und mehr Komfort während der Ganzkörper-Immobilisation im Vergleich zum Spineboard.

Abstract

Background and objectives

The question about the need of spinal immobilization of trauma patients in general, and the various ways to do it in particular are nowadays increasingly discussed in scientific literature. Furthermore, daily practice of spinal immobilization routines also reflects a huge heterogeneity. The aim of this article is to give an overview about exemplarily selected literature on the subject of spinal immobilization of trauma patients. Thus, possible recommendations concerning spinal immobilization could be derived by the reader.

Spinal immobilization of trauma patients

The general lack of evidence towards spinal immobilization is well known. In the current scientific literature increasing hints can be found that the sole application of a cervical collar does not ensure a sufficient immobilization of the cervical spine. Thus, total spine immobilization, meaning fixation of the entire body of the trauma patient is recommended. However, total spine immobilization is also said to be associated with significant complications such as aggravated airway management or reduced lung function due to restrictions. Furthermore, the application of a cervical collar can lead to increased intracranial pressure. Thus, the indication for spinal immobilization should be sophisticated on behalf of immobilization decision tools such as the Canadian C-spine rule. In patients with acute life threatening conditions such as Hemorrhagic shock, it must be decided whether the immediate transport can be delayed by immobilization procedures. In the case of a trauma patient suffering from severe traumatic brain injury, one should consider whether the application of a cervical collar is mandatory or if alternative ways of immobilization could be carried out. Hence, the vacuum mattress offers better stability and greater comfort during total spinal immobilization compared to the spine board.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland

    M. Kreinest, S. Goller & M. Münzberg

  2. PHTLS Europe Research Group, Offenbach/Queich, Deutschland

    M. Kreinest, B. Gliwitzky, S. Goller & M. Münzberg

  3. PHTLS Deutschland, Offenbach/Queich, Deutschland

    M. Kreinest, B. Gliwitzky, S. Goller & M. Münzberg

  4. MegaMed Notfallmanagement GbR, Annweiler, Deutschland

    B. Gliwitzky

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  1. M. Kreinest
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  2. B. Gliwitzky
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  3. S. Goller
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  4. M. Münzberg
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Correspondence to M. Kreinest.

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Interessenkonflikt

M. Kreinest, B. Gliwitzky, S. Goller und M. Münzberg sind Instruktoren bei PHTLS. M. Kreinest und M. Münzberg sind zusätzlich Medizinische Kursdirektoren bei PHTLS. M. Kreinest ist Medizinischer Direktor bei RTTLS. M. Münzberg ist Kursdirektor bei ATLS. M. Münzberg und B. Gliwitzky sind Mitglieder des Europäischen PHTLS Boards. B. Gliwitzky ist Vorsitzender des PHTLS-Programms in Deutschland und Geschäftsführender Gesellschafter bei MegaMed Notfallmanagement.

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Kreinest, M., Gliwitzky, B., Goller, S. et al. Präklinische Immobilisation der Wirbelsäule. Notfall Rettungsmed 19, 41–47 (2016). https://doi.org/10.1007/s10049-015-0118-5

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  • DOI: https://doi.org/10.1007/s10049-015-0118-5

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