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DOI: 10.1055/a-2370-7019
Notfallthorakotomie – Übersicht, Indikation und Zugänge
Emergency Thoracotomy – Overview, Indications and Surgical Approaches
Die Notfallthorakotomie stellt eine lebensrettende, jedoch seltene Maßnahme bei Patienten mit traumatischem Kreislaufstillstand oder in extremis dar. Während die Überlebensraten stark von Verletzungsmuster, Lebenszeichen und zeitkritischer Durchführung abhängen, bleibt die Indikationsstellung ein kontrovers diskutiertes Thema. Dieser Artikel gibt eine umfassende Übersicht zu Indikationen, Zugängen und Behandlung möglicher Pathologien.
Abstract
The emergency thoracotomy is a life-saving but rare procedure for patients in extremis or with traumatic cardiac arrest. While survival rates strongly depend on the injury pattern, presence of vital signs, and timely intervention, the indication for this procedure remains a subject of ongoing debate. This article provides a comprehensive overview of indications, surgical approaches, and the management of potential pathologies.
Publication History
Article published online:
22 May 2025
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Literatur
- 1 Pape HC, Lefering R, Butcher N. et al. The definition of polytrauma revisited: An international consensus process and proposal of the new ‘Berlin definition’. J Trauma Acute Care Surg 2014; 77: 780-786
- 2 Jahresbericht 2023 TraumaRegister DGU®. Höfer C, Lefering R. 2023 Accessed May 07, 2025 at: https://www.auc-online.de/fileadmin/AUC/Dokumente/Register/TraumaRegister_DGU/TR-DGU-Jahresbericht_2023a.pdf
- 3 Dongel I, Coskun A, Ozbay S. et al. Management of thoracic trauma in emergency service: Analysis of 1139 cases. Pak J Med Sci 2013; 29: 58-63
- 4 Hines MH, Meredith JW. Special Problems of thoracic Trauma. In: Ritchie WP, Steele jr G, Dean RH. , Hrsg. General Surgery. Philadelphia: JB Lippincott; 1995: 859-872
- 5 Galvagno SM, Nahmias JT, Young DA. Advanced Trauma Life Support Update 2019. Anesthesiology Clinics 2019; 37: 13-32
- 6 Rott N, Dirks B, Böttiger BW. Die neuen Reanimationsleitlinien 2021 in der deutschen Übersetzung – die BIG-FIVE-Überlebensstrategien gewinnen deutlich an Bedeutung. Notfall Rettungsmed 2021; 24: 271-273
- 7 Yamamoto L, Schroeder C, Morley D. et al. Thoracic trauma: the deadly dozen. Crit Care Nurs Q 2005; 28: 22-40
- 8 Truhlář A, Deakin CD, Soar J. et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95: 148-201
- 9 Karmy-Jones R, Jurkovich GJ, Nathens AB. et al. Timing of urgent thoracotomy for hemorrhage after trauma: a multicenter study. Arch Surg 2001; 136: 513-518
- 10 Karmy-Jones R, Jurkovich GJ. Blunt chest trauma. Curr Probl Surg 2004; 41: 223-380
- 11 Bleetman A, Kasem H, Crawford R. Review of emergency thoracotomy for chest injuries in patients attending a UK Accident and Emergency department. Injury 1996; 27: 129-132
- 12 Ivatury RR, Kazigo J, Rohman M. et al. “Directed” emergency room thoracotomy: a prognostic prerequisite for survival. J Trauma 1991; 31: 1076-1081
- 13 Rhee PM, Acosta J, Bridgeman A. Centre for Reviews and Dissemination (UK). et al. Survival after emergency department thoracotomy: review of published data from the past 25 yearsDatabase of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. 2000 Accessed May 07, 2025 at: https://www.ncbi.nlm.nih.gov/books/NBK68160/
- 14 Branney SW, Moore EE, Feldhaus KM. et al. Critical Analysis of Two Decades of Experience with Postinjury Emergency Department Thoracotomy in a Regional Trauma Center. J Trauma 1998; 45: 87-94
- 15 Nevins EJ, Bird NTE, Malik HZ. et al. A systematic review of 3251 emergency department thoracotomies: is it time for a national database?. Eur J Trauma Emerg Surg 2019; 45: 231-243
- 16 Kuhajda I, Zarogoulidis K, Kougioumtzi I. et al. Penetrating trauma. J Thorac Dis 2014; 6 (Suppl. 4) S461-S465
- 17 Davies GE, Lockey DJ. Thirteen survivors of prehospital thoracotomy for penetrating trauma: a prehospital physician-performed resuscitation procedure that can yield good results. J Trauma 2011; 70: E75-78
- 18 Lockey DJ, Lyon RM, Davies GE. Development of a simple algorithm to guide the effective management of traumatic cardiac arrest. Resuscitation 2013; 84: 738-742
- 19 Deutsche Gesellschaft für Unfallchirurgie e. V.. S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung (AWMF-Registernummer 187–023), Version 4.0. 31.12.2022 Accessed October 22, 2024 at: https://www.awmf.org/leitlinien/detail/ll/187-023.html
- 20 Joint Trauma System Clinical Practice Guideline. Emergent Resuscitative Thoracotomy (ERT)Clinical Practice Guidelines (CPGs). 2018 Accessed May 07, 2025 at: https://jts.health.mil/assets/docs/cpgs/Emergent_Resuscitative_Thoracotomy_ERT_18_Jul_2018_ID20.pdf
- 21 Burlew CC, Moore EE, Moore FA. et al. Western Trauma Association Critical Decisions in Trauma: Resuscitative thoracotomy. J Trauma Acute Care Surg 2012; 73: 1359-1363
- 22 Seamon MJ, Haut ER, Van Arendonk K. et al. An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2015; 79: 159-173
- 23 Aseni P, Rizzetto F, Grande AM. et al. Emergency Department Resuscitative Thoracotomy: Indications, surgical procedure and outcome. A narrative review. Am J Surg 2021; 221: 1082-1092
- 24 Kleber C, Giesecke MT, Tsokos M. et al. Overall distribution of trauma-related deaths in Berlin 2010: advancement or stagnation of German trauma management?. World J Surg 2012; 36: 2125-2130
- 25 McNamara JJ, Messersmith JK, Dunn RA. et al. Thoracic injuries in combat casualties in Vietnam. Ann Thorac Surg 1970; 10: 389-401
- 26 Waydhas C, Nast-Kolb D. [Chest injury. Part II: Management of specific injuries]. Unfallchirurg 2006; 109: 881-892
- 27 Daugaard C, Pedersen AB, Kristensen NR. et al. Preoperative antithrombotic therapy and risk of blood transfusion and mortality following hip fracture surgery: a Danish nationwide cohort study. Osteoporos Int 2019; 30: 583-591
- 28 Huber-Wagner S, Biberthaler P, Häberle S. et al. Whole-body CT in haemodynamically unstable severely injured patients--a retrospective, multicentre study. PLoS One 2013; 8: e68880
- 29 Kanz KG, Paul AO, Lefering R. et al. Trauma management incorporating focused assessment with computed tomography in trauma (FACTT) – potential effect on survival. J Trauma Manag Outcomes 2010; 4: 4
- 30 Rudolph M, Lange T, Göring M. et al. Clamshell-Thorakotomie im Rettungsdienst und Schockraum: Indikationen, Anforderungen und Technik. Notarzt 2019; 35: 199-207
- 31 Hirshberg A, Mattox KL. Die Trauma-Thorakotomie ohne Wenn und AberTop Knife: Kunst und Handwerk der Trauma-Chirurgie. Wien, New York: Springer; 2006
- 32 Asensio JA, Chahwan S, Forno W. et al. Penetrating esophageal injuries: multicenter study of the American Association for the Surgery of Trauma. J Trauma 2001; 50: 289-296
- 33 Spodick DH. Acute cardiac tamponade. N Engl J Med 2003; 349: 684-690
- 34 Nagy KK, Lohmann C, Kim DO. et al. Role of Echocardiography in the Diagnosis of Occult Penetrating Cardiac Injury. J Trauma 1995; 38: 859-862