Dahmen Janosch, Brade Marko, Gerach Christian, Glombitza Martin, Schmitz Jan, Zeitter Simon, Steinhausen Eva
BG Klinikum Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland.
Luftrettungszentrum CHRISTOPH 9, Großenbaumer Allee 250, 47249, Duisburg, Deutschland.
Unfallchirurg. 2018 Oct;121(10):839-849. doi: 10.1007/s00113-018-0516-5.
The European Resuscitation Council guidelines for resuscitation in patients with traumatic cardiac arrest recommend the immediate treatment of all reversible causes, if necessary even prior to continuous chest compression. In the case of cardiac tamponade immediate emergency thoracotomy should also be considered.
The authors report the case of a 23-year-old male patient with multiple injuries including blunt thoracic trauma, which caused a witnessed cardiac arrest. He successfully underwent prehospital emergency resuscitative thoracotomy. The lessons learned from this case on internal and external quality measures are discussed in detail.
After 60 min of technical rescue, extensive trauma life support including intubation, chest decompression and bleeding control was carried out. The cardiovascular insufficiency progressively deteriorated and under the suspicion of a cardiac tamponade a prehospital emergency thoracotomy was carried out. After successful resuscitative thoracotomy and return of spontaneous circulation (ROSC) the patient was airlifted to the next level 1 trauma center for damage control surgery (DCS). The patient could be discharged 59 days after the accident and now 2 years later is living a normal life without neurological or cardiopulmonary limitations. Airway management, chest decompression including resuscitative thoracotomy, fluid resuscitation and blood products were the key components to ensure that the patient achieved ROSC. Advanced Trauma Life Support® as well as structural prerequisites made these measures and good results for the patient possible.
欧洲复苏委员会关于创伤性心脏骤停患者复苏的指南建议，如有必要，即使在持续胸外按压之前，也应立即处理所有可逆转的病因。对于心脏压塞，也应考虑立即进行紧急开胸手术。
作者报告了一例23岁男性多发伤患者的病例，包括钝性胸部创伤，导致目击心脏骤停。他成功接受了院前紧急复苏开胸手术。详细讨论了从该病例中吸取的关于内部和外部质量措施的经验教训。
经过60分钟的技术救援后，进行了包括插管、胸部减压和出血控制在内的广泛创伤生命支持。心血管功能不全逐渐恶化，在怀疑心脏压塞的情况下进行了院前紧急开胸手术。成功进行复苏开胸手术并恢复自主循环（ROSC）后，患者被空运至下一级别的1级创伤中心进行损伤控制手术（DCS）。患者在事故发生59天后出院，现在2年后过着正常生活，没有神经或心肺功能限制。气道管理、包括复苏开胸手术在内的胸部减压、液体复苏和血液制品是确保患者实现ROSC的关键组成部分。高级创伤生命支持（Advanced Trauma Life Support®）以及结构前提条件使这些措施和患者的良好结果成为可能。
