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Prähospitale Anwendung von Tourniquets bei lebensbedrohlichen Extremitätenblutungen

Eine systematische Übersichtsarbeit

Prehospital application of tourniquets for life-threatening extremity hemorrhage

Systematic review of literature

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Abstract

Hintergrund

Gemäß der Handlungsempfehlung „Tourniquet“ der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) erfolgt die Anlage eines Tourniquets bei lebensbedrohlichen Extremitätenblutungen, wenn die Kompression der Wunde nicht ausreicht oder in der gegebenen Situation nicht durchführbar ist. Hierdurch wird ein fortdauernder, unkontrollierbarer Blutverlust vermieden.

Material und Methode

Anhand der Ergebnisse einer systematischen Literaturrecherche (Januar 2015 bis Januar 2018) wird die publizierte Handlungsempfehlung Tourniquet der DGAI kritisch reevaluiert. Hierfür sind 17 Fragen zu 6 Themen im Vorfeld formuliert. Die PRISMA-Empfehlungen werden eingehalten, und die Studie ist im International Prospective Register of Systematic Reviews (PROSPERO; ID CRD42018091528) registriert.

Ergebnisse

Von 284 Treffern zur Stichwortsuche „Tourniquet“ und „Trauma“ im Suchzeitraum von Januar 2015 bis Januar 2018 bei PubMed werden 50 Originalarbeiten zur prähospitalen Anwendung von Tourniquets bei lebensbedrohlichen Extremitätenblutungen in die Auswertung inkludiert. Zu keiner vorformulierten Frage kann eine prospektive randomisierte Interventionsstudie gefunden werden. Nur indirekt, meist als deskriptive Beschreibung, lassen sich wissenschaftliche Rückschlüsse ziehen.

Schlussfolgerung

Bei insgesamt sehr inhomogener Studienlage werden die bestehenden Aussagen der 2016 publizierten Handlungsempfehlung zur prähospitalen Anwendung von Tourniquets der DGAI bestätigt. Eine Abweichung ergibt sich zur „Konversion des Tourniquets“. Diese wird im zivilen Rettungsdienst bei den geringen Transportzeiten kaum nötig sein. Zukünftig könnte in dieser Frage jedoch strikt unterschieden werden, zwischen Tourniquets, die aus taktischer, und solchen, die aus medizinischer Notwendigkeit angelegt wurden.

Abstract

Introduction

The effectiveness of a tourniquet in the case of life-threatening hemorrhages of the extremities is well recognized and led to the recommendations on “Tourniquet” of the German Society of Anaesthesiology and Intensive Care (DGAI) in 2016. The aim of this systematic review was to re-evaluate the current medical literature in relation to the published DGAI recommendations.

Material and methods

Based on the analysis of all studies published from January 2015 until January 2018 in the PubMed databases, the publicized recommendations for action on “Tourniquet” of the DGAI were critically re-evaluated. For this purpose, 17 questions on 6 subjects were formulated in advance. The systematic review followed the PRISMA recommendations and is registered in PROSPERO (International prospective register of systematic reviews, Reg.-ID: CRD42018091528).

Results

Of the 284 studies identified with the keywords tourniquet and trauma in the period from January 2015 to January 2018 in PubMed, 50 original papers discussing the prehospital application of tourniquet for life-threatening hemorrhage of the extremities were included. The overall level of evidence is low. No article addressed any of the formulated questions with a prospective randomized interventional study. Scientific deductions could be found only in an indirect way in a descriptive manner.

Conclusion

The 50 original articles included in this qualitative, systematic review revealed that the recommendations “Tourniquet” of the DGAI published in 2016 are mostly still up to date despite an inhomogeneous study situation. A deviation occurred in the conversion of a tourniquet but due to the short prehospital treatment time in the civilian setting this is of little importance; however, in the future a strict distinction should be made between tourniquets which were placed for tactical reasons and those placed as a medical necessity.

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Danksagung

Dr. S. Holsträter gilt ein besonderer Dank für die redaktionelle Überarbeitung der Einzelbeiträge sowie der Abbildungen.

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Authors and Affiliations

  1. Klinik für Anästhesiologie und Intensivmedizin, Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland

    B. Hossfeld, R. Lechner, F. Josse, M. Helm &  M. Kulla DESA

  2. Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland

    M. Bernhard

  3. Arbeitsgruppe „Trauma- und Schockraummanagement“, Arbeitskreis Notfallmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, Nürnberg, Deutschland

    M. Bernhard

  4. Universitätsklinik für Unfallchirurgie, Universitätsklinikum Magdeburg, Magdeburg, Deutschland

    F. Walcher

  5. Arbeitsgruppe „Taktische Medizin“, Arbeitskreises Notfallmedizin, Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, Nürnberg, Deutschland

    B. Hossfeld, F. Josse, M. Helm &  M. Kulla DESA

  6. Tactical Rescue and Emergency Medicine Association (TREMA e. V.), Tübingen, Deutschland

    B. Hossfeld, R. Lechner & F. Josse

  7. Sektion Notfall‑, Intensivmedizin und Schwerverletztenversorgung (NIS), Deutsche Gesellschaft für Unfallchirurgie (DGU), Berlin, Deutschland

    F. Walcher &  M. Kulla DESA

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  1. B. Hossfeld
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  4. M. Bernhard
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  6. M. Helm
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  7. M. Kulla DESA
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B. Hossfeld, R. Lechner, F. Josse, M. Bernhard, F. Walcher, M. Helm und M. Kulla geben an, dass kein Interessenkonflikt besteht.

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Hossfeld, B., Lechner, R., Josse, F. et al. Prähospitale Anwendung von Tourniquets bei lebensbedrohlichen Extremitätenblutungen. Unfallchirurg 121, 516–529 (2018). https://doi.org/10.1007/s00113-018-0510-y

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