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Notfall + Rettungsmedizin

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20.04.2023 | Volumenersatz | Leitthema

Die Kapitel „Stop the Bleed – Prähospital“ sowie „Gerinnungsmanagement und Volumentherapie (Schockraum)“ in der neuen S3-Leitlinie „Polytrauma/Schwerverletzten-Behandlung“

verfasst von: Dr. med. H. Lier, Dr. K. Gooßen, Dr. med. H. Trentzsch

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 4/2023

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Zusammenfassung

Die S3-Leitlinie „Polytrauma/Schwerverletzten-Behandlung“ der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) wurde zwischen 2020 und 2022 aktualisiert und überarbeitet. Der vorliegende Beitrag beschreibt die Kernaussagen des neuen Kapitels „Stop the Bleed – Prähospital“ sowie des komplett überarbeiteten Kapitels „Gerinnungsmanagement und Volumentherapie“.

Akbari E, Safari S, Hatamabadi H (2018) The effect of fibrinogen concentrate and fresh frozen plasma on the outcome of patients with acute traumatic coagulopathy: a quasi-experimental study. Am J Emerg Med 36:1947–1950. https://doi.org/10.1016/j.ajem.2018.02.018CrossRefPubMed

Al-Jeabory M, Szarpak L, Attila K et al (2021) Efficacy and safety of tranexamic acid in emergency trauma: a systematic review and meta-analysis. J Clin Med. https://doi.org/10.3390/jcm10051030CrossRefPubMedPubMedCentral

Albert V, Subramanian A, Pati HP et al (2019) Efficacy of thromboelastography (TEG) in predicting acute trauma-induced coagulopathy (ATIC) in isolated severe traumatic brain injury (iSTBI). Indian J Hematol Blood Transfus 35:325–331. https://doi.org/10.1007/s12288-018-1003-4CrossRefPubMed

Arbeitsgemeinschaft Der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (2023) AWMF-Leitlinie 187–023: überarbeitete S3-Leitlinie Polytrauma / Schwerverletzten-Behandlung. https://register.awmf.org/assets/guidelines/187-023l_S3_Polytrauma-Schwerverletzten-Behandlung_2023-02.pdf. Zugegriffen: 14. Febr. 2023

Arbeitsgemeinschaft Der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) (2020) Ständige Kommission Leitlinien AWMF-Regelwerk „Leitlinien“. http://www.awmf.org/leitlinien/awmf-regelwerk.html. Zugegriffen: 4. Juli 2022

Baksaas-Aasen K, Gall LS, Stensballe J et al (2021) Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial. Intensive Care Med 47:49–59. https://doi.org/10.1007/s00134-020-06266-1CrossRefPubMed

Balendran CA, Lovgren A, Hansson KM et al (2017) Prothrombin time is predictive of low plasma prothrombin concentration and clinical outcome in patients with trauma hemorrhage: analyses of prospective observational cohort studies. Scand J Trauma Resusc Emerg Med 25:30. https://doi.org/10.1186/s13049-016-0332-2CrossRefPubMedPubMedCentral

Barrett CD, Moore HB, Vigneshwar N et al (2020) Plasmin thrombelastography rapidly identifies trauma patients at risk for massive transfusion, mortality, and hyperfibrinolysis: a diagnostic tool to resolve an international debate on tranexamic acid? J Trauma Acute Care Surg 89:991–998. https://doi.org/10.1097/TA.0000000000002941CrossRefPubMed

Berger-Groch J, Rueger JM, Czorlich P et al (2021) Evaluation of pelvic circular compression devices in severely injured trauma patients with pelvic fractures. Prehosp Emerg Care. https://doi.org/10.1080/10903127.2021.1945717CrossRefPubMed

10.

Bouillon B, Marzi I (2018) The updated German “Polytrauma—Guideline”: an extensive literature evaluation and treatment recommendation for the care of the critically injured patient. Eur J Trauma Emerg Surg 44:1. https://doi.org/10.1007/s00068-018-0949-0CrossRefPubMed

11.

Bugaev N, Como JJ, Golani G et al (2020) Thromboelastography and rotational thromboelastometry in bleeding patients with coagulopathy: practice management guideline from the eastern association for the surgery of trauma. J Trauma Acute Care Surg 89:999–1017. https://doi.org/10.1097/TA.0000000000002944CrossRefPubMed

12.

Bui E, Inaba K, Ebadat A et al (2016) The impact of increased plasma ratios in massively transfused trauma patients: a prospective analysis. Eur J Trauma Emerg Surg 42:519–525. https://doi.org/10.1007/s00068-015-0573-1CrossRefPubMed

13.

Bundesärztekammer (BÄK) (2020) Querschnitts-Leitlinien (BÄK) zur Therapie mit Blutkomponenten und Plasmaderivaten – Gesamtnovelle 2020. https://www.bundesaerztekammer.de/aerzte/medizin-ethik/wissenschaftlicher-beirat/veroeffentlichungen/haemotherapietransfusionsmedizin/querschnitt-leitlinie/. Zugegriffen: 10. Jan. 2021

14.

Byrne JP, Mason SA, Gomez D et al (2016) Timing of pharmacologic venous thromboembolism prophylaxis in severe traumatic brain injury: a propensity-matched cohort study. J Am Coll Surg 223:621–631.e5. https://doi.org/10.1016/j.jamcollsurg.2016.06.382CrossRefPubMed

15.

Cardenas JC, Zhang X, Fox EE et al (2018) Platelet transfusions improve hemostasis and survival in a substudy of the prospective, randomized PROPPR trial. Blood Adv 2:1696–1704. https://doi.org/10.1182/bloodadvances.2018017699CrossRefPubMedPubMedCentral

16.

Carrick MM, Morrison CA, Tapia NM et al (2016) Intraoperative hypotensive resuscitation for patients undergoing laparotomy or thoracotomy for trauma: early termination of a randomized prospective clinical trial. J Trauma Acute Care Surg 80:886–896. https://doi.org/10.1097/TA.0000000000001044CrossRefPubMed

17.

Cerny V, Maegele M, Agostini V et al (2021) Variations and obstacles in the use of coagulation factor concentrates for major trauma bleeding across Europe: outcomes from a European expert meeting. Eur J Trauma Emerg Surg. https://doi.org/10.1007/s00068-020-01563-2CrossRefPubMedPubMedCentral

18.

Chehab M, Ditillo M, Obaid O et al (2021) Never-frozen liquid plasma transfusion in civilian trauma: a nationwide propensity-matched analysis. J Trauma Acute Care Surg 91:200–205. https://doi.org/10.1097/TA.0000000000003116CrossRefPubMed

19.

Chowdary P, Saayman AG, Paulus U et al (2004) Efficacy of standard dose and 30 ml/kg fresh frozen plasma in correcting laboratory parameters of haemostasis in critically ill patients. Br J Haematol 125:69–73. https://doi.org/10.1111/j.1365-2141.2004.04868.xCrossRefPubMed

20.

Clasper JC, Brown KV, Hill P (2009) Limb complications following pre-hospital tourniquet use. J R Army Med Corps 155:200–202. https://doi.org/10.1136/jramc-155-03-06CrossRefPubMed

21.

Cohen J, Scorer T, Wright Z et al (2019) A prospective evaluation of thromboelastometry (ROTEM) to identify acute traumatic coagulopathy and predict massive transfusion in military trauma patients in Afghanistan. Transfusion 59:1601–1607. https://doi.org/10.1111/trf.15176CrossRefPubMed

22.

Cole E, Weaver A, Gall L et al (2021) A decade of damage control resuscitation: new transfusion practice, new survivors, new directions. Ann Surg 273:1215–1220. https://doi.org/10.1097/SLA.0000000000003657CrossRefPubMed

23.

Coleman JR, Moore EE, Samuels JM et al (2021) Whole blood thrombin generation in severely injured patients requiring massive transfusion. J Am Coll Surg 232:709–716. https://doi.org/10.1016/j.jamcollsurg.2020.12.058CrossRefPubMedPubMedCentral

24.

Connelly CR, Yonge JD, Mccully SP et al (2017) Assessment of three point-of-care platelet function assays in adult trauma patients. J Surg Res 212:260–269. https://doi.org/10.1016/j.jss.2017.01.008CrossRefPubMed

25.

Cooper DJ, Nichol AD, Bailey M et al (2018) Effect of early sustained prophylactic hypothermia on neurologic outcomes among patients with severe traumatic brain injury: the POLAR randomized clinical trial. JAMA 320:2211–2220. https://doi.org/10.1001/jama.2018.17075CrossRefPubMedPubMedCentral

26.

Crash‑2 Trial Collaborators (2019) Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet 394:1713–1723. https://doi.org/10.1016/s0140-6736(19)32233-0CrossRef

27.

Crash‑2 Trial Collaborators, Shakur H, Roberts I et al (2010) Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 376:23–32. https://doi.org/10.1016/S0140-6736(10)60835-5 %CrossRef

28.

Curry N, Foley C, Wong H et al (2018) Early fibrinogen concentrate therapy for major haemorrhage in trauma (E-FIT 1): results from a UK multi-centre, randomised, double blind, placebo-controlled pilot trial. Crit Care 22:164. https://doi.org/10.1186/s13054-018-2086-xCrossRefPubMedPubMedCentral

29.

Darlington DN, Kheirabadi BS, Scherer MR et al (2012) Acidosis and correction of acidosis does not affect rFVIIa function in swine. Int J Burns Trauma 2:145–157PubMedPubMedCentral

30.

de Roulet A, Kerby JD, Weinberg JA et al (2020) Group A emergency-release plasma in trauma patients requiring massive transfusion. J Trauma Acute Care Surg 89:1061–1067. https://doi.org/10.1097/TA.0000000000002903CrossRefPubMedPubMedCentral

31.

Fligor SC, Love KM, Collier BR et al (2017) Parathyroid hormone as a marker for hypoperfusion in trauma: a prospective observational study. J Trauma Acute Care Surg 83:1142–1147. https://doi.org/10.1097/TA.0000000000001656CrossRefPubMed

32.

Gale SC, Kocik JF, Creath R et al (2016) A comparison of initial lactate and initial base deficit as predictors of mortality after severe blunt trauma. J Surg Res 205:446–455. https://doi.org/10.1016/j.jss.2016.06.103CrossRefPubMed

33.

Garcia Callejo FJ, Munoz Fernandez N, Achiques Martinez MT et al (2010) Nasal packing in posterior epistaxis. Comparison of two methods. Acta Otorrinolaringol Esp 61:196–201. https://doi.org/10.1016/j.otorri.2009.11.005CrossRefPubMed

34.

Garrigue D, Godier A, Glacet A et al (2018) French lyophilized plasma versus fresh frozen plasma for the initial management of trauma-induced coagulopathy: a randomized open-label trial. J Thromb Haemost 16:481–489. https://doi.org/10.1111/jth.13929CrossRefPubMed

35.

Gonzalez E, Moore EE, Moore HB et al (2016) Goal-directed hemostatic resuscitation of trauma-induced coagulopathy: a pragmatic randomized clinical trial comparing a viscoelastic assay to conventional coagulation assays. Ann Surg 263:1051–1059. https://doi.org/10.1097/SLA.0000000000001608CrossRefPubMed

36.

Gratz J, Schlimp CJ, Honickel M et al (2020) Sufficient thrombin generation despite 95 % hemodilution: an in vitro experimental study. J Clin Med. https://doi.org/10.3390/jcm9123805CrossRefPubMedPubMedCentral

37.

Gu X, Wang S, Chen J et al (2020) Restricted fluid resuscitation improves the prognosis of patients with traumatic hemorrhagic shock. Int J Clin Exp Med 13:5319–5327

38.

Guyette FX, Brown JB, Zenati MS et al (2020) Tranexamic acid during prehospital transport in patients at risk for hemorrhage after injury: a double-blind, placebo-controlled, randomized clinical trial. JAMA Surg. https://doi.org/10.1001/jamasurg.2020.4350CrossRefPubMedPubMedCentral

39.

Hagemo JS, Christiaans SC, Stanworth SJ et al (2015) Detection of acute traumatic coagulopathy and massive transfusion requirements by means of rotational thromboelastometry: an international prospective validation study. Crit Care 19:97. https://doi.org/10.1186/s13054-015-0823-yCrossRefPubMedPubMedCentral

40.

Han J, Ren HQ, Zhao QB et al (2015) Comparison of 3 % and 7.5 % hypertonic saline in resuscitation after traumatic hypovolemic shock. Shock 43:244–249. https://doi.org/10.1097/SHK.0000000000000303CrossRefPubMed

41.

Hatamabadi HR, Asayesh Zarchi F, Kariman H et al (2015) Celox-coated gauze for the treatment of civilian penetrating trauma: a randomized clinical trial. Trauma Mon 20:e23862. https://doi.org/10.5812/traumamon.23862CrossRefPubMedPubMedCentral

42.

Henry R, Matsushima K, Ghafil C et al (2021) Increased use of prehospital tourniquet and patient survival: Los Angeles countywide study. J Am Coll Surg 233:233–239.e2. https://doi.org/10.1016/j.jamcollsurg.2021.03.023CrossRefPubMed

43.

Hifumi T, Kuroda Y, Kawakita K et al (2017) Therapeutic hypothermia in patients with coagulopathy following severe traumatic brain injury. Scand J Trauma Resusc Emerg Med 25:120. https://doi.org/10.1186/s13049-017-0465-yCrossRefPubMedPubMedCentral

44.

Holcomb JB, Jenkins D, Rhee P et al (2007) Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma 62:307–310. https://doi.org/10.1097/TA.0b013e3180324124CrossRefPubMed

45.

Hutchings SD, Naumann DN, Hopkins P et al (2018) Microcirculatory impairment is associated with multiple organ dysfunction following traumatic hemorrhagic shock: the MICROSHOCK study. Crit Care Med 46:e889–e896. https://doi.org/10.1097/CCM.0000000000003275CrossRefPubMed

46.

Imach S, Wafaisade A, Lefering R et al (2021) The impact of prehospital tranexamic acid on mortality and transfusion requirements: match-pair analysis from the nationwide German TraumaRegister DGU(R). Crit Care 25:277. https://doi.org/10.1186/s13054-021-03701-7CrossRefPubMedPubMedCentral

47.

Innerhofer N, Treichl B, Rugg C et al (2021) First-line administration of fibrinogen concentrate in the bleeding trauma patient: searching for effective dosages and optimal post-treatment levels limiting massive transfusion-further results of the RETIC study. J Clin Med. https://doi.org/10.3390/jcm10173930CrossRefPubMedPubMedCentral

48.

Innerhofer P, Fries D, Mittermayr M et al (2017) Reversal of trauma-induced coagulopathy using first-line coagulation factor concentrates or fresh frozen plasma (RETIC): a single-centre, parallel-group, open-label, randomised trial. Lancet Haematol 4:e258–e271. https://doi.org/10.1016/s2352-3026(17)30077-7CrossRefPubMed

49.

Irajpour A, Kaji NS, Nazari F et al (2012) A comparison between the effects of simple and traction splints on pain intensity in patients with femur fractures. Iran J Nurs Midwifery Res 17:530–533PubMedPubMedCentral

50.

Jones AR, Bush HM, Frazier SK (2017) Injury severity, sex, and transfusion volume, but not transfusion ratio, predict inflammatory complications after traumatic injury. Heart Lung 46:114–119. https://doi.org/10.1016/j.hrtlng.2016.12.002CrossRefPubMed

51.

Jones AR, Frazier SK (2014) Increased mortality in adult patients with trauma transfused with blood components compared with whole blood. J Trauma Nurs 21:22–29. https://doi.org/10.1097/JTN.0000000000000025CrossRefPubMedPubMedCentral

52.

Kabeer M, Venugopalan PP, Subhash VC (2019) Pre-hospital hemorrhagic control effectiveness of Axiostat(R) dressing versus conventional method in acute hemorrhage due to trauma. Cureus 11:e5527. https://doi.org/10.7759/cureus.5527CrossRefPubMedPubMedCentral

53.

Kauvar DS, Miller D, Walters TJ (2018) Tourniquet use is not associated with limb loss following military lower extremity arterial trauma. J Trauma Acute Care Surg 85:495–499. https://doi.org/10.1097/TA.0000000000002016CrossRefPubMed

54.

Khan M, Jehan F, Bulger EM et al (2018) Severely injured trauma patients with admission hyperfibrinolysis: Is there a role of tranexamic acid? Findings from the PROPPR trial. J Trauma Acute Care Surg 85:851–857. https://doi.org/10.1097/TA.0000000000002022CrossRefPubMedPubMedCentral

55.

Kolev K, Longstaff C (2016) Bleeding related to disturbed fibrinolysis. Br J Haematol 175:12–23. https://doi.org/10.1111/bjh.14255CrossRefPubMedPubMedCentral

56.

Kragh JF Jr., Dubick MA, Aden JK et al (2015) U.S. Military use of tourniquets from 2001 to 2010. Prehosp Emerg Care 19:184–190. https://doi.org/10.3109/10903127.2014.964892CrossRefPubMed

57.

Kragh JF Jr., Nam JJ, Berry KA et al (2015) Transfusion for shock in US military war casualties with and without tourniquet use. Ann Emerg Med 65:290–296. https://doi.org/10.1016/j.annemergmed.2014.10.021CrossRefPubMed

58.

Kunhahamed MO, Abraham SV, Palatty BU et al (2019) A comparison of internal jugular vein cannulation by ultrasound-guided and anatomical landmark technique in resource-limited emergency department setting. J Med Ultrasound 27:187–191. https://doi.org/10.4103/JMU.JMU_2_19CrossRefPubMedPubMedCentral

59.

Kutcher ME, Kornblith LZ, Vilardi RF et al (2014) The natural history and effect of resuscitation ratio on coagulation after trauma: a prospective cohort study. Ann Surg 260:1103–1111. https://doi.org/10.1097/SLA.0000000000000366CrossRefPubMed

60.

Lier H, Maegele M (2019) Blutungsmanagement: Tranexamsäure in der Präklinik. Pro und Kontra. Notfall Rettungsmed 22:685–695. https://doi.org/10.1007/s10049-018-0471-2CrossRef

61.

Lier H, Bernhard M, Hossfeld B (2018) Hypovolämisch-hämorrhagischer Schock. Anaesthesist 67:225–244. https://doi.org/10.1007/s00101-018-0411-zCrossRefPubMed

62.

Lier H et al (2019) Tranexamic acid for acute hemorrhage: a narrative review of landmark studies and a critical reappraisal of its use over the last decade. Anesth Analg 129:1574–84. https://doi.org/10.1213/ANE.0000000000004389CrossRefPubMed

63.

Lu Y, Liu L, Wang J et al (2018) Controlled blood pressure elevation and limited fluid resuscitation in the treatment of multiple injuries in combination with shock. Pak J Med Sci 34:1120–1124. https://doi.org/10.12669/pjms.345.15465CrossRefPubMedPubMedCentral

64.

Maekawa T, Yamashita S, Nagao S et al (2015) Prolonged mild therapeutic hypothermia versus fever control with tight hemodynamic monitoring and slow rewarming in patients with severe traumatic brain injury: a randomized controlled trial. J Neurotrauma 32:422–429. https://doi.org/10.1089/neu.2013.3197CrossRefPubMedPubMedCentral

65.

Makris M, Iorio A (2019) Prehospital fresh frozen plasma: universal life saver or treatment in search of a target population? Res Pract Thromb Haemost 3:12–14. https://doi.org/10.1002/rth2.12172CrossRefPubMed

66.

Mckenzie JE, Brennan SE, Ryan RE et al (2022) Defining the criteria for including studies and how they will be grouped for the synthesis. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (Hrsg) Cochrane handbook for systematic reviews of interventions version 6.3

67.

Meizoso JP, Dudaryk R, Mulder MB et al (2018) Increased risk of fibrinolysis shutdown among severely injured trauma patients receiving tranexamic acid. J Trauma Acute Care Surg 84:426–432. https://doi.org/10.1097/TA.0000000000001792CrossRefPubMed

68.

Moore HB, Moore EE, Chapman MP et al (2017) Viscoelastic tissue plasminogen activator challenge predicts massive transfusion in 15 minutes. J Am Coll Surg 225:138–147. https://doi.org/10.1016/j.jamcollsurg.2017.02.018CrossRefPubMedPubMedCentral

69.

Moore HB, Moore EE, Huebner BR et al (2017) Tranexamic acid is associated with increased mortality in patients with physiological fibrinolysis. J Surg Res 220:438–443. https://doi.org/10.1016/j.jss.2017.04.028CrossRefPubMedPubMedCentral

70.

Moore HB, Moore EE, Neal MD et al (2019) Fibrinolysis shutdown in trauma: historical review and clinical implications. Anesth Analg 129:762–773. https://doi.org/10.1213/ANE.0000000000004234CrossRefPubMedPubMedCentral

71.

Moore HB, Tessmer MT, Moore EE et al (2020) Forgot calcium? Admission ionized-calcium in two civilian randomized controlled trials of prehospital plasma for traumatic hemorrhagic shock. J Trauma Acute Care Surg 88:588–596. https://doi.org/10.1097/TA.0000000000002614CrossRefPubMedPubMedCentral

72.

Nascimento B, Callum J, Tien H et al (2016) Fibrinogen in the initial resuscitation of severe trauma (FiiRST): a randomized feasibility trial. Br J Anaesth 117:775–782. https://doi.org/10.1093/bja/aew343CrossRefPubMed

73.

Nederpelt CJ, El Hechi MW, Kongkaewpaisan N et al (2020) Fresh frozen plasma-to-packed red blood cell ratio and mortality in traumatic hemorrhage: nationwide analysis of 4,427 patients. J Am Coll Surg 230:893–901. https://doi.org/10.1016/j.jamcollsurg.2019.10.012CrossRefPubMed

74.

Nishijima DK, Kuppermann N, Roberts I et al (2019) The effect of tranexamic acid on functional outcomes: an exploratory analysis of the CRASH‑2 randomized controlled trial. Ann Emerg Med 74:79–87. https://doi.org/10.1016/j.annemergmed.2018.11.018CrossRefPubMed

75.

Pehle B, Nast-Kolb D, Oberbeck R et al (2003) Significance of physical examination and radiography of the pelvis during treatment in the shock emergency room. Unfallchirurg 106:642–648. https://doi.org/10.1007/s00113-003-0629-2CrossRefPubMed

76.

Peng HT, Nascimento B, Tien H et al (2019) A comparative study of viscoelastic hemostatic assays and conventional coagulation tests in trauma patients receiving fibrinogen concentrate. Clin Chim Acta 495:253–262. https://doi.org/10.1016/j.cca .2019.04.066CrossRefPubMed

77.

Pierrie SN, Seymour RB, Wally MK et al (2021) Pilot randomized trial of pre-hospital advanced therapies for the control of hemorrhage (PATCH) using pelvic binders. Am J Emerg Med 42:43–48. https://doi.org/10.1016/j.ajem.2020.12.082CrossRefPubMed

78.

Pizanis A, Pohlemann T, Burkhardt M et al (2013) Emergency stabilization of the pelvic ring: clinical comparison between three different techniques. Injury 44:1760–1764. https://doi.org/10.1016/j.injury.2013.07.009CrossRefPubMed

79.

Pusateri AE, Moore EE, Moore HB et al (2020) Association of prehospital plasma transfusion with survival in trauma patients with hemorrhagic shock when transport times are longer than 20 minutes: a post hoc analysis of the PAMPer and COMBAT clinical trials. JAMA Surg 155:e195085. https://doi.org/10.1001/jamasurg.2019.5085CrossRefPubMed

80.

Quine EJ, Murray L, Trapani T et al (2021) Thromboelastography to assess coagulopathy in traumatic brain injury patients undergoing therapeutic hypothermia. Ther Hypothermia Temp Manag 11:53–57. https://doi.org/10.1089/ther.2020.0025CrossRefPubMed

81.

Reitz KM, Moore HB, Guyette FX et al (2020) Prehospital plasma in injured patients is associated with survival principally in blunt injury: results from two randomized prehospital plasma trials. J Trauma Acute Care Surg 88:33–41. https://doi.org/10.1097/TA.0000000000002485CrossRefPubMedPubMedCentral

82.

Rizoli S, Min A, Sanchez AP et al (2016) In trauma, conventional ROTEM and TEG results are not interchangeable but are similar in clinical applicability. Mil Med 181:117–126. https://doi.org/10.7205/MILMED-D-15-00166CrossRefPubMed

83.

Roberts I, Edwards P, Prieto D et al (2017) Tranexamic acid in bleeding trauma patients: an exploration of benefits and harms. Trials 18:48. https://doi.org/10.1186/s13063-016-1750-1CrossRefPubMedPubMedCentral

84.

Roberts I, Prieto-Merino D, Manno D (2014) Mechanism of action of tranexamic acid in bleeding trauma patients: an exploratory analysis of data from the CRASH‑2 trial. Crit Care 18:685. https://doi.org/10.1186/s13054-014-0685-8CrossRefPubMedPubMedCentral

85.

Roquet F, Neuschwander A, Hamada S et al (2019) Association of early, high plasma-to-red blood cell transfusion ratio with mortality in adults with severe bleeding after trauma. JAMA Netw Open 2:e1912076. https://doi.org/10.1001/jamanetworkopen.2019.12076CrossRefPubMedPubMedCentral

86.

Rossetto A, Vulliamy P, Lee KM et al (2022) Temporal transitions in fibrinolysis after trauma: adverse outcome is principally related to late hypofibrinolysis. Anesthesiology 136:148–161. https://doi.org/10.1097/ALN.0000000000004036CrossRefPubMed

87.

Rowell SE, Meier EN, Mcknight B et al (2020) Effect of out-of-hospital tranexamic acid vs placebo on 6‑month functional neurologic outcomes in patients with moderate or severe traumatic brain injury. JAMA 324:961–974. https://doi.org/10.1001/jama.2020.8958CrossRefPubMedPubMedCentral

88.

Schellenberg M, Benjamin E, Inaba K et al (2021) When is it safe to start pharmacologic venous thromboembolism prophylaxis after pelvic fractures? A prospective study from a level I trauma center. J Surg Res 258:272–277. https://doi.org/10.1016/j.jss.2020.08.077CrossRefPubMed

89.

Schellenberg M, Inaba K, Biswas S et al (2019) When is it safe to start VTE prophylaxis after blunt solid organ injury? A prospective study from a level I trauma center. World J Surg 43:2797–2803. https://doi.org/10.1007/s00268-019-05096-7CrossRefPubMed

90.

Schlimp CJ, Ponschab M, Voelckel W et al (2016) Fibrinogen levels in trauma patients during the first seven days after fibrinogen concentrate therapy: a retrospective study. Scand J Trauma Resusc Emerg Med 24:29. https://doi.org/10.1186/s13049-016-0221-8CrossRefPubMedPubMedCentral

91.

Schochl H, Voelckel W, Maegele M et al (2014) Endogenous thrombin potential following hemostatic therapy with 4‑factor prothrombin complex concentrate: a 7-day observational study of trauma patients. Crit Care 18:R147. https://doi.org/10.1186/cc13982CrossRefPubMedPubMedCentral

92.

Schweigkofler U, Wincheringer D, Holstein J et al (2022) How effective are different models of pelvic binders: results of a study using a pelvic emergency simulator. Eur J Trauma Emerg Surg 48:847–855. https://doi.org/10.1007/s00068-020-01406-0CrossRefPubMed

93.

Schweigkofler U, Wohlrath B, Trentsch H et al (2018) Diagnostics and early treatment in prehospital and emergency-room phase in suspicious pelvic ring fractures. Eur J Trauma Emerg Surg 44:747–752. https://doi.org/10.1007/s00068-017-0860-0CrossRefPubMed

94.

Schweigkofler U, Wohlrath B, Trentzsch H et al (2021) Is there any benefit in the pre-hospital application of pelvic binders in patients with suspected pelvic injuries? Eur J Trauma Emerg Surg 47:493–498. https://doi.org/10.1007/s00068-019-01239-6CrossRefPubMed

95.

Shea SM, Staudt AM, Thomas KA et al (2020) The use of low-titer group O whole blood is independently associated with improved survival compared to component therapy in adults with severe traumatic hemorrhage. Transfusion 60(3):S2–S9. https://doi.org/10.1111/trf.15696CrossRefPubMed

96.

Shlamovitz GZ, Mower WR, Bergman J et al (2009) How (un)useful is the pelvic ring stability examination in diagnosing mechanically unstable pelvic fractures in blunt trauma patients? J Trauma 66:815–820. https://doi.org/10.1097/TA.0b013e31817c96e1CrossRefPubMed

97.

Spagnolello O, Reed MJ, Dauncey S et al (2020) Introduction of a ROTEM protocol for the management of trauma-induced coagulopathy. Trauma 23:308–321. https://doi.org/10.1177/1460408620957919CrossRef

98.

Spahn DR, Bouillon B, Cerny V et al (2019) The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care 23:98. https://doi.org/10.1186/s13054-019-2347-3CrossRefPubMedPubMedCentral

99.

Spinella PC, Thomas KA, Turnbull IR et al (2020) The immunologic effect of early intravenous two and four gram bolus dosing of tranexamic acid compared to placebo in patients with severe traumatic bleeding (TAMPITI): a randomized, double-blind, placebo-controlled, single-center trial. Front Immunol 11:2085. https://doi.org/10.3389/fimmu.2020.02085CrossRefPubMedPubMedCentral

100.

Stanworth SJ, Davenport R, Curry N et al (2016) Mortality from trauma haemorrhage and opportunities for improvement in transfusion practice. Br J Surg 103:357–365. https://doi.org/10.1002/bjs.10052CrossRefPubMed

101.

Stevens WT, Morse BC, Bernard A et al (2017) Incompatible type A plasma transfusion in patients requiring massive transfusion protocol: outcomes of an eastern association for the surgery of trauma multicenter study. J Trauma Acute Care Surg 83:25–29. https://doi.org/10.1097/TA.0000000000001532CrossRefPubMed

102.

Taghavi S, Maher Z, Goldberg AJ et al (2021) An eastern association for the surgery of trauma multicenter trial examining prehospital procedures in penetrating trauma patients. J Trauma Acute Care Surg 91:130–140. https://doi.org/10.1097/TA.0000000000003151CrossRefPubMedPubMedCentral

103.

Vigneshwar NG, Moore EE, Moore HB et al (2022) Precision medicine: clinical tolerance to hyperfibrinolysis differs by shock and injury severity. Ann Surg 275:e605–e607. https://doi.org/10.1097/SLA.0000000000004548CrossRefPubMed

104.

Winstanley M, Smith JE, Wright C (2019) Catastrophic haemorrhage in military major trauma patients: a retrospective database analysis of haemostatic agents used on the battlefield. J R Army Med Corps 165:405–409. https://doi.org/10.1136/jramc-2018-001031CrossRefPubMed

105.

Zeeshan M, Hamidi M, Feinstein AJ et al (2019) Four-factor prothrombin complex concentrate is associated with improved survival in trauma-related hemorrhage: a nationwide propensity-matched analysis. J Trauma Acute Care Surg 87:274–281. https://doi.org/10.1097/TA.0000000000002262CrossRefPubMed

106.

Zhang LM, Li R, Sun WB et al (2019) Low-dose, early fresh frozen plasma transfusion therapy after severe trauma brain injury: a clinical, prospective, randomized, controlled study. World Neurosurg 132:e21–e27. https://doi.org/10.1016/j.wneu.2019.09.024CrossRefPubMed

107.

Zhou H, Zhang N, Zhou H et al (2018) Influence of phased body temperature management for severe abdominal traumatic patients with hemorrhagic shock. Int J Clin Exp Med 11:4056–4063

108.

Zielinski MD, Schrager JJ, Johnson P et al (2015) Multicenter comparison of emergency release group A versus AB plasma in blunt-injured trauma patients. Clin Transl Sci 8:43–47. https://doi.org/10.1111/cts.12206CrossRefPubMed

Titel: Die Kapitel „Stop the Bleed – Prähospital“ sowie „Gerinnungsmanagement und Volumentherapie (Schockraum)“ in der neuen S3-Leitlinie „Polytrauma/Schwerverletzten-Behandlung“
verfasst von: Dr. med. H. Lier
Dr. K. Gooßen
Dr. med. H. Trentzsch
Publikationsdatum: 20.04.2023
Verlag: Springer Medizin
Schlagwörter: Volumenersatz
Schock
Pflege
Polytrauma
Polytrauma
Tranexamsäure
Schock
Erschienen in: Notfall + Rettungsmedizin / Ausgabe 4/2023
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI: https://doi.org/10.1007/s10049-023-01147-8

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Die Kapitel „Stop the Bleed – Prähospital“ sowie „Gerinnungsmanagement und Volumentherapie (Schockraum)“ in der neuen S3-Leitlinie „Polytrauma/Schwerverletzten-Behandlung“

Zusammenfassung

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Zusammenfassung

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